Self-reported non-adherence to P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: Application of the medication non-adherence academic research consortium classification
Self-reported non-adherence to P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: Application of the medication non-adherence academic research consortium classification
Blog Article
Aims The Non-adherence Academic Research Consortium (NARC) has recently developed a consensus-based standardized classification for medication non-adherence in cardiovascular clinical trials.We aimed to assess the prevalence of NARC-defined self-reported non-adherence to P2Y12 inhibitors and its impact on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI).Methods and results Using a standardized questionnaire administered at 1 year after PCI, we assessed the 4 NARC-defined non-adherence levels including type, decision-maker, reasons, and timing within the Bern PCI registry.The primary endpoint was the patient-oriented composite endpoint (POCE) defined as a composite of death, myocardial infarction, stroke, and any revascularization at 1 year.
The recommended P2Y12 inhibitor duration was 12 months.Among 3,896 patients, Knife Set P2Y12 inhibitor non-adherence was observed in 647 (17%) patients.Discontinuation was permanent in the majority of patients (84%).The decision was mainly driven by a physician (94%), and rarely by patients (6%).
The most frequent reason was risk profile change (43%), followed by unlisted reasons (25%), surgery (17%), and adverse events (14%).Non-adherence occurred early (180 days) in 33%.The majority of POCE events (n = 421/502, 84%) occurred during adherence to the prescribed P2Y12 inhibitor.Permanent discontinuation, doctor-driven non-adherence, and risk profile change emerged as independent predictors for POCE.
Conclusions In real-world PCI population treated with 1-year DAPT, non-adherence was observed in nearly one-fifth of Coat Conditioners patients.Non-adherence to P2Y12 inhibitors was associated with worse clinical outcomes, while the risk was related to underlying contexts.ClinicalTrials.gov identifier NCT02241291.