Frequency and Reasons of Dual Antiplatelet Therapy Discontinuation and Switching of P2Y12 Inhibitors in Patients with Acute Coronary Syndrome Treated with Stent Implantation.

BACKGROUND: Incidence and reasons of dual antiplatelet therapy (DAPT) discontinuation and switching between P2Y12 inhibitors in acute coronary syndrome (ACS) patients treated with a stent have been poorly studied. METHODS AND RESULTS: In a prospective single-center study, 283 consecutive patients presenting with ACS were treated with stent implantation between July 2015 and January 2016. Follow-up was achieved at 12 months in 273 patients using the electronic patient file and telephone interview. Switching from clopidogrel to a new antiplatelet agent (ticagrelor or prasugrel) or vice versa occurred in 60 (21.2%) patients. The most frequent reasons for switching were medical decisions not associated with bleeding events and concomitant use of chronic oral anticoagulation. Among the patients with a 1-year follow-up, 42 (15.4%) prematurely discontinued DAPT; 25 of them did so due to the need for an invasive procedure. DAPT premature discontinuation was not significantly associated with an increased 1-year risk of cardiovascular death or serious cardiac ischemic events (HR 2.08 [CI 95%: 0.88-4.94, p = 0.099]). CONCLUSIONS: DAPT discontinuation and switching between P2Y12 inhibitors are not uncommon in patients with ACS treated with a stent. The most frequent reasons were the need for an invasive procedure and medical decisions.

Analysis of medium-term adherence after the implementation of a cardiac rehabilitation program.

OBJECTIVES: Cardiac Rehabilitation Programs (CRP) are an excellent tool to achieve adherence to therapeutic. The aim of our study was analyzing at the medium-term adherence, as well as identifying low adherence predictors to pharmacological therapeutic compliance and changes in lifestyle. METHODS: Retrospective study of 100 patients referred to a CRP in 2018 after presenting ACS. At the one-year review adherence to diet, physical exercise, and smoking cessation were analyzed. Optimal adherence was considered if all three items were met. Compliance with taking medication was also studied using the Morisky-Green test. Finally, low adherence predictors were analyzed by lineal/logistic regression analysis. RESULTS: 98% of the patients presented acceptable adherence to the Mediterranean diet, 83% good adherence to physical exercise, and 79% of the smokers achieved the cessation of smoking. Regarding drug adherence, 97% of the patients complied correctly. 68% of the patients achieved good overall adherence. Eastern European nationality, sedentary lifestyle, and home-based CRP were predictors of low adherence. The youngest patients and the "blue collar" occupation showed a tendency to poor adherence, although not significantly. CONCLUSIONS: In our environment there is good medium-term adherence to lifestyle changes and pharmacological compliance in patients who complete CRP after ACS. Eastern European nationality, sedentary lifestyle, and home-based programs were associated with poor adherence.

OBJETIVO: Los programas de rehabilitación cardiaca (PRC) son una excelente herramienta para lograr adherencia al cumplimiento terapéutico. El objetivo fue analizar la adherencia a medio plazo e identificar predictores de mala adherencia al cumplimiento farmacológico y a los cambios en el estilo de vida. MATERIAL Y MÉTODOS: Estudio retrospectivo de 100 pacientes remitidos a un PRC en 2018 tras un síndrome coronario agudo (SCA). En la revisión al año se analizó la adherencia a la dieta, al ejercicio físico y la deshabituación tabáquica. Se consideró adherencia óptima si se cumplían los tres ítems. Se estudió el cumplimiento farmacológico empleando el test de Morisky-Green. Se analizaron los predictores de mala adherencia mediante análisis de regresión lineal/logística. RESULTADOS: El 98% de los pacientes presentaron adherencia aceptable a la dieta mediterránea, el 83% buena adherencia al ejercicio físico y el 79% de los fumadores consiguieron dejar de fumar. Respecto a la adherencia farmacológica, el 97% de los pacientes la cumplió de forma correcta. En conjunto consiguieron una adherencia óptima el 68% de los pacientes. La nacionalidad de Europa del este, el sedentarismo y los programas no presenciales fueron predictores de mala adherencia. Los pacientes más jóvenes y la profesión de «cuello azul¼ mostraron tendencia a mala adherencia, aunque no de forma significativa. CONCLUSIONES: En nuestro entorno existe una buena adherencia a los cambios de estilo de vida y al cumplimiento farmacológico en pacientes que tras un SCA completan un PRC. La nacionalidad Europea del este, el sedentarismo y los programas no presenciales se asociaron con mala adherencia.

Sex-specific differences in antithrombotic therapy and prognosis in patients with acute coronary syndrome treated with stent.

Aims and objective: Impact of sex-related differences in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention and treated with new P2Y12 inhibitors is not adequately characterised. We aimed to analyse gender-based differences in dual antiplatelet therapy, and adverse cardiovascular events and bleeding. Materials and methods: Prospective-observational study of the consecutive ACS patients treated with stent from July 2016 to January 2016, with a follow-up of 1 year. Results: We examined 283 patients, 75 (26.5%) women and 208 (73.5%) men. Women were older than men (71 ± 13 vs. 66,5 ± 13 years). There were 44% of women and 52% of men presenting with ST-elevation ACS (p = 0.21). Women had a higher bleeding risk (CRUSADE), without differences in the ischaemic risk (GRACE and TIMI). More women were treated with drug-eluting stent (88.9 vs. 75.5%, p = 0.04). There was a lower rate of ticagrelor prescription in women (42.6 vs. 50.9%, p = 0.29), in favour of clopidogrel. No differences were observed in prasugrel prescription. No significant differences were observed after a year of follow up, but women had a tendency towards lower mortality (1.4 vs. 6.7%, p = 0.19) and higher bleeding rates (23.3 vs. 17.4%, p = 0.27). Conclusions: In our study of patients presenting with ACS treated with stent, clopidogrel was preferred in women, whereas ticagrelor was the most frequent prescription in men. No significant differences were noted in clinical outcomes, but women experienced a tendency towards less mortality and more bleeding events.

Antecedentes y objetivo: El interés sobre la influencia del sexo en pacientes con síndrome coronario agudo (SCA) tratados con stent y nuevos antiagregantes inhibidores de P2Y12 en la práctica clínica es creciente. Se analizan las diferencias en función del sexo en el tratamiento con doble antiagregación plaquetaria (DAPT) y los eventos adversos isquémicos y hemorrágicos. Materiales y métodos: Estudio prospectivo de pacientes consecutivos con diagnóstico de SCA tratados con stent coronario desde julio de 2015 hasta enero de 2016. Resultados: De un total de 283 pacientes incluidos, 75 (26.5%) correspondió a mujeres y 208 (73.5%) a hombres. La edad media fue de 71 ± 13 y 66.5 ± 13 años, respectivamente. Un 44% de mujeres se presentó como SCA con elevación del segmento ST contra un 52.4 de los hombres, p = 0.21. Las mujeres mostraron un mayor riesgo de sangrado (CRUSADE), sin diferencias en el riesgo isquémico (GRACE y TIMI). Se usaron stents farmacoactivos con más frecuencia en mujeres (88.9 vs. 75.5%, p = 0.04). Se observó una tendencia de menor prescripción del ticagrelor en mujeres (42.6 vs. 50.9%, p = 0.29) en favor de un mayor uso del clopidogrel. No se identificaron diferencias en cuanto a la prescripción del prasugrel. Las mujeres presentaron al año una menor mortalidad (1.4 vs. 6.7%, p = 0.19), aunque mayor sangrado (23.3 vs. 17.4%, p = 0.27). Conclusiones: En este estudio de pacientes consecutivos con SCA tratados con stent se registró una mayor prescripción de clopidogrel en las mujeres que en los hombres. Las mujeres presentaron una menor incidencia anual de mortalidad, pero mayor sangrado en comparación con los hombres, no significativo.

Análisis de la adherencia a medio plazo tras la realización de un programa de rehabilitación cardiaca / Analysis of medium-term adherence after the implementation of a cardiac rehabilitation program

Resumen Objetivo: Los programas de rehabilitación cardiaca (PRC) son una excelente herramienta para lograr adherencia al cumplimiento terapéutico. El objetivo fue analizar la adherencia a medio plazo e identificar predictores de mala adherencia al cumplimiento farmacológico y a los cambios en el estilo de vida. Material y métodos: Estudio retrospectivo de 100 pacientes remitidos a un PRC en 2018 tras un síndrome coronario agudo (SCA). En la revisión al año se analizó la adherencia a la dieta, al ejercicio físico y la deshabituación tabáquica. Se consideró adherencia óptima si se cumplían los tres ítems. Se estudió el cumplimiento farmacológico empleando el test de Morisky-Green. Se analizaron los predictores de mala adherencia mediante análisis de regresión lineal/logística. Resultados: El 98% de los pacientes presentaron adherencia aceptable a la dieta mediterránea, el 83% buena adherencia al ejercicio físico y el 79% de los fumadores consiguieron dejar de fumar. Respecto a la adherencia farmacológica, el 97% de los pacientes la cumplió de forma correcta. En conjunto consiguieron una adherencia óptima el 68% de los pacientes. La nacionalidad de Europa del este, el sedentarismo y los programas no presenciales fueron predictores de mala adherencia. Los pacientes más jóvenes y la profesión de «cuello azul¼ mostraron tendencia a mala adherencia, aunque no de forma significativa. Conclusiones: En nuestro entorno existe una buena adherencia a los cambios de estilo de vida y al cumplimiento farmacológico en pacientes que tras un SCA completan un PRC. La nacionalidad Europea del este, el sedentarismo y los programas no presenciales se asociaron con mala adherencia.

Abstract Objectives: Cardiac Rehabilitation Programs (CRP) are an excellent tool to achieve adherence to therapeutic. The aim of our study was analyzing at the medium-term adherence, as well as identifying low adherence predictors to pharmacological therapeutic compliance and changes in lifestyle. Methods: Retrospective study of 100 patients referred to a CRP in 2018 after presenting ACS. At the one-year review adherence to diet, physical exercise, and smoking cessation were analyzed. Optimal adherence was considered if all three items were met. Compliance with taking medication was also studied using the Morisky-Green test. Finally, low adherence predictors were analyzed by lineal/logistic regression analysis. Results: 98% of the patients presented acceptable adherence to the Mediterranean diet, 83% good adherence to physical exercise, and 79% of the smokers achieved the cessation of smoking. Regarding drug adherence, 97% of the patients complied correctly. 68% of the patients achieved good overall adherence. Eastern European nationality, sedentary lifestyle, and home-based CRP were predictors of low adherence. The youngest patients and the "blue collar" occupation showed a tendency to poor adherence, although not significantly. Conclusions: In our environment there is good medium-term adherence to lifestyle changes and pharmacological compliance in patients who complete CRP after ACS. Eastern European nationality, sedentary lifestyle, and home-based programs were associated with poor adherence.

Diferencias en el tratamiento antitrombótico y pronóstico en función del sexo en pacientes con síndrome coronario agudo tratados con stent / Sex-specific differences in antithrombotic therapy and prognosis in patients with acute coronary syndrome treated with stent

Resumen Antecedentes y objetivo: El interés sobre la influencia del sexo en pacientes con síndrome coronario agudo (SCA) tratados con stent y nuevos antiagregantes inhibidores de P2Y12 en la práctica clínica es creciente. Se analizan las diferencias en función del sexo en el tratamiento con doble antiagregación plaquetaria (DAPT) y los eventos adversos isquémicos y hemorrágicos Materiales y métodos: Estudio prospectivo de pacientes consecutivos con diagnóstico de SCA tratados con stent coronario desde julio de 2015 hasta enero de 2016. Resultados: De un total de 283 pacientes incluidos, 75 (26.5%) correspondió a mujeres y 208 (73.5%) a hombres. La edad media fue de 71 ± 13 y 66.5 ± 13 años, respectivamente. Un 44% de mujeres se presentó como SCA con elevación del segmento ST contra un 52.4 de los hombres, p = 0.21. Las mujeres mostraron un mayor riesgo de sangrado (CRUSADE), sin diferencias en el riesgo isquémico (GRACE y TIMI). Se usaron stents farmacoactivos con más frecuencia en mujeres (88.9 vs. 75.5%, p = 0.04). Se observó una tendencia de menor prescripción del ticagrelor en mujeres (42.6 vs. 50.9%, p = 0.29) en favor de un mayor uso del clopidogrel. No se identificaron diferencias en cuanto a la prescripción del prasugrel. Las mujeres presentaron al año una menor mortalidad (1.4 vs. 6.7%, p = 0.19), aunque mayor sangrado (23.3 vs. 17.4%, p = 0.27). Conclusiones: En este estudio de pacientes consecutivos con SCA tratados con stent se registró una mayor prescripción de clopidogrel en las mujeres que en los hombres. Las mujeres presentaron una menor incidencia anual de mortalidad, pero mayor sangrado en comparación con los hombres, no significativo.

Abstract Aims and objective: Impact of sex-related differences in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention and treated with new P2Y12 inhibitors is not adequately characterised. We aimed to analyse gender-based differences in dual antiplatelet therapy, and adverse cardiovascular events and bleeding. Materials and methods: Prospective-observational study of the consecutive ACS patients treated with stent from July 2016 to January 2016, with a follow-up of 1 year. Results: We examined 283 patients, 75 (26.5%) women and 208 (73.5%) men. Women were older than men (71 ± 13 vs. 66,5 ± 13 years). There were 44% of women and 52% of men presenting with ST-elevation ACS (p = 0.21). Women had a higher bleeding risk (CRUSADE), without differences in the ischaemic risk (GRACE and TIMI). More women were treated with drug-eluting stent (88.9 vs. 75.5%, p = 0.04). There was a lower rate of ticagrelor prescription in women (42.6 vs. 50.9%, p = 0.29), in favour of clopidogrel. No differences were observed in prasugrel prescription. No significant differences were observed after a year of follow up, but women had a tendency towards lower mortality (1.4 vs. 6.7%, p = 0.19) and higher bleeding rates (23.3 vs. 17.4%, p = 0.27). Conclusions: In our study of patients presenting with ACS treated with stent, clopidogrel was preferred in women, whereas ticagrelor was the most frequent prescription in men. No significant differences were noted in clinical outcomes, but women experienced a tendency towards less mortality and more bleeding events.