RESUMO
BACKGROUND: The impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available. METHODS: We followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases. RESULTS: Discontinuation of clopidogrel within the first 3 months after stent implantation was associated with a significantly increased rate of MACE at 1-year follow-up (hazard ratio (HR) 2.06; 95% confidence interval (CI): 1.08-3.93). Discontinuation 3-6 months (HR 1.29; 95% CI: 0.70-2.41) and 6-12 months (HR 1.29; 95% CI: 0.54-3.07) after stent implantation were associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation. CONCLUSIONS: Discontinuation of clopidogrel was associated with an increased rate of MACE among patients treated with drug-eluting stents. The increase was statistically significant within the first 3 months after drug-eluting stent implantation but not after 3 to 12 months.
Assuntos
Stents Farmacológicos , Adesão à Medicação , Intervenção Coronária Percutânea/instrumentação , Inibidores da Agregação Plaquetária/administração & dosagem , Ticlopidina/análogos & derivados , Idoso , Clopidogrel , Trombose Coronária/etiologia , Trombose Coronária/mortalidade , Trombose Coronária/prevenção & controle , Dinamarca , Esquema de Medicação , Prescrições de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ticlopidina/administração & dosagem , Fatores de Tempo , Resultado do TratamentoRESUMO
Danish emergency departments (EDs) are undergoing a reorganisation in which the EDs are changed to serve as the single portal of entry for all acute patients. This survey-based study evaluates the entry to the Danish hospitals for acute cardiac patients. In 62% of the EDs there is not a cardiologist on call around the clock, thus compromising the availability of echocardiography and cardiac supervision. The handling of cardiac patients varies and the quality in the visitation and admission of these patients fluctuates. Pre-hospital findings should be used consequently to triage cardiac patients.