Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement : Results from the PREMIER registry

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-06, Vol.113 (24), p.2803-2809
• Main Authors: SPERTUS, John A, KETTELKAMP, Richard, KRUMHOLZ, Harlan M, COHEN, David J, VANCE, Clifton, DECKER, Carole, JONES, Philip G, RUMSFELD, John S, MESSENGER, John C, KHANAL, Sanjaya, PETERSON, Eric D, BACH, Richard G
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biological and medical sciences; Blood and lymphatic vessels; Blood. Blood coagulation. Reticuloendothelial system; Cardiology. Vascular system; Cardiovascular Agents - therapeutic use; Cause of Death; Combined Modality Therapy; Coronary Restenosis - mortality; Coronary Restenosis - prevention & control; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drug Administration Schedule; Drug Implants; Drug toxicity and drugs side effects treatment; Female; Follow-Up Studies; Hospitalization - statistics & numerical data; Humans; Life Tables; Male; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Mortality; Myocardial Infarction - drug therapy; Myocardial Infarction - therapy; Patient Education as Topic; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - therapeutic use; Prevalence; Proportional Hazards Models; Prospective Studies; Pyridines - administration & dosage; Pyridines - therapeutic use; Registries; Sirolimus - administration & dosage; Sirolimus - therapeutic use; Stents; Survival Analysis; Thrombosis - prevention & control; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Treatment Outcome; Treatment Refusal
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.618066

Although drug-eluting stents (DES) significantly reduce restenosis, they require 3 to 6 months of thienopyridine therapy to prevent stent thrombosis. The rate and consequences of prematurely discontinuing thienopyridine therapy after DES placement for acute myocardial infarction (MI) are unknown. We used prospectively collected data from a 19-center study of MI patients to examine the prevalence and predictors of thienopyridine discontinuation 30 days after DES treatment. We then compared the mortality and cardiac hospitalization rates for the next 11 months between those who stopped and those who continued thienopyridine therapy. Among 500 DES-treated MI patients who were discharged on thienopyridine therapy, 68 (13.6%) stopped therapy within 30 days. Those who stopped were older, less likely to have completed high school or be married, more likely to avoid health care because of cost, and more likely to have had preexisting cardiovascular disease or anemia at presentation. They were also less likely to have received discharge instructions about their medications or a cardiac rehabilitation referral. Patients who stopped thienopyridine therapy by 30 days were more likely to die during the next 11 months (7.5% versus 0.7%, P