Identifying Patients at Risk for Premature Discontinuation of Thienopyridine After Coronary Stent Implantation
Identifying Patients at Risk for Premature Discontinuation of Thienopyridine After Coronary Stent Implantation
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DOI：
10.1016/j.amjcard.2010.10.045
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发表时间：
2011-03-01
影响因子：
2.8
通讯作者：
Lopes, Renato D.
中科院分区：
文献类型：
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作者：
Quadros, Alexandre S.;Welter, Dulce I.;Lopes, Renato D.
我们试图找出过早停用硫代吡啶的患者，并制定硫代吡啶在冠状动脉支架植入后依从性的风险评分。研究对象为2007年12月至2008年3月期间的患者。在1个月的随访中，所有患者都接受了Morisky问卷调查，并询问他们是否停止服用硫代吡啶。多变量分析确定了硫代吡啶停药的预测因素；根据优势比为每个变量分配分数，并计算分数的c-统计量。纳入的400名患者的平均年龄为61.0+/-10.4岁；66名患者(16.5%)在1个月后停用硫代吡啶。停止治疗的原因是费用(62%)、缺乏信息(17%)和另一位医生建议停止治疗(15%)。与戒烟相关的因素包括未婚状态(优势比2.48，p=0.046)、没有私人医疗保险(优势比4.68，p=0.041)、急性冠脉综合征(优势比2.31，p=0.004)、非糖尿病患者(优势比2.20，p=0.041)、以及收入是最低工资的2倍(优势比8.23，p<；0.001)和2至3倍(优势比4.46，p=0.021)的患者。总风险评分为0至14分，并与硫代吡啶的停用密切相关。总分分别为0~4分、5~8分、9~12分和<13分的患者中，分别有0%、7%、20%和37%的患者停用了硫代吡啶类药物(c-统计量0.76，p<；0.0001)。风险评分也与莫里斯基问卷评估的完全依从性显著相关(c-统计量0.74p<；0.001)。总而言之，我们使用支架植入前获得的变量确定了有过早停止硫代吡啶治疗风险的患者，并开发了准确预测硫代吡啶过早停止治疗的风险评分。(C)2011 Elsevier Inc.保留所有权利。(美国心脏杂志2011；107：685-689)
We sought to identify patients at risk for premature discontinuation of thienopyridines and to develop a risk score for thienopyridine adherence after coronary stent implantation. Patients were prospectively included from December 2007 to March 2008. At 1-month follow-up, all patients were given the Morisky questionnaire and asked if they had stopped taking thienopyridines. Multivariate analysis identified predictors of thienopyridine discontinuation; points were assigned to each variable according to the odds ratios and the c-statistic of the score was calculated. Mean age of the 400 patients included was 61.0 +/- 10.4 years; 66 patients (16.5%) stopped thienopyridines after 1 month. Reasons for discontinuation were cost (62%), lack of informatim (17%), and recommendation by another doctor to stop treatment (15%). Factors associated with discontinuation included unmarried status (odds ratio 2.48, p = 0.046), lack of private health insurance (odds ratio 4.68, p = 0.041), acute coronary syndrome (odds ratio 2.31, p = 0.004), nondiabetics (odds ratio 2.20, p = 0.041), and patients who earned < 2 times (odds ratio 8.23, p < 0.001) and 2 to 3 times (odds ratio 4.46, p = 0.021) the minimum wage. Total risk score was 0 to 14 points and was strongly associated with thienopyridine discontinuation. For total scores of 0 to 4, 5 to 8, 9 to 12, and >= 13, 0%, 7%, 20%, and 37% of patients, respectively, stopped thienopyridines (c-statistic 0.76, p < 0.0001). Risk score was also significantly associated with complete adherence as assessed by Morisky questionnaire (c-statistic 0.74, p < 0.001). In conclusion, we have identified patients at risk for premature discontinuation of thienopyridines using variables obtained before stent implantation and developed a risk score that accurately predicts premature thienopyridine discontinuation. (c) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:685-689)