Clinical InvestigationInterventional CardiologyPatterns of use of thienopyridine therapy after percutaneous coronary interventions with drug-eluting stents and bare-metal stents
Section snippets
Data sources
The Cardiac Care Network of Ontario (CCNO) collects a prospective clinical registry of all patients undergoing cardiac invasive procedures in Ontario.15, 16 Clinical nurse coordinators at each cardiac center gather information on demographics, clinical characteristics, and relevant comorbid conditions. Details on PCI procedures were added in 2003.15, 16
The Ontario Drug Benefit prescription claims database was used to determine thienopyridine use (clopidogrel and ticlopidine) after PCI
Baseline characteristics
After exclusion criteria were applied, our cohort included 5,263 patients who received DES and 6,081 patients who received BMS. Among patients who received DES, the mean age was 73 years, 61.7% were male, and 35.6% had an acute myocardial infarction within the past month (Table I). Annual deductible and dispensing fees were waived for 19.4% of patients who had a low personal or household income (Table I).
Many demographic and clinical characteristics were observed at similar proportions among
Discussion
The availability of a population-based PCI cohort with complete prescription medication data afforded an opportunity to gain new insights into the pattern of use of thienopyridine after PCI. Despite strong recommendation from practice guidelines to take thienopyridine therapy in an uninterrupted fashion for 12 months, we found that 6.9% of patients never filled a single prescription after hospital discharge, 1 in 5 patients had suboptimal adherence, and >1 in 4 patients discontinued
Disclosures
Funding/Support: Dr Ko is supported by a Clinician-Scientist award from the Heart and Stroke Foundation of Ontario (HSFO) and a New Investigator award by CIHR. Dr Austin is supported by a Career Investigator Award by the HSFO. Dr Tu is supported by a Canada Research Chair in Health Services Research and a Career Investigator Award from the HSFO. The Institute for Clinical Evaluative Sciences is funded by an annual grant from the Ontario MOHLTC. The CCNO is funded by the MOHLTC.
Acknowledgements
We acknowledge that the data used in this publication are from the CCNO and its member hospitals. The CCNO serves as an advisory body to the Ministry of Health and Long-Term Care (MOHLTC) and is dedicated to improving the quality, efficiency, access, and equity of adult cardiovascular services in Ontario, Canada. We would like to acknowledge the support from the Ontario Health Technology Advisory Committee and the Medical Advisory Secretariat, and funding from the MOHLTC to the Programs for
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