Initiation and persistence with clopidogrel treatment after acute myocardial infarction – a nationwide study

Authors


  • Authors' contributions: All authors have seen and approved the final version of the manuscript. R.S.: Concept and design of the study, analysis and interpretation of data and results, drafting the manuscript, responsible for revision and final version of manuscript. C.T-P., S.Z.A. and G.H.G.: Contributed to the concept and design of the study, analysis and interpretation of data and critical revision of manuscript. L.K., J.K.M. and E.L.F.: Contributed to thorough critical review of the manuscript and interpretation of data. S.R.: Provided statistical expertise, interpretation of data and critical revision of manuscript.

Dr Rikke Sørensen MD, Research Fellow, Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65–Post 4210, 2900 Hellerup, Denmark.
Tel: +45 3997 8608
Fax: +45 3977 7381
E-mail: rs@heart.dk

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Treatment with clopidogrel after myocardial infarction (MI) is recommended to almost all patients for 12 months.

• There is interpatient variation in the effect of clopidogrel treatment, one possible explanation for this being low initiation or poor persistence with therapy.

WHAT THIS STUDY ADDS

• We found remarkably high initiation and persistence with clopidogrel treatment among MI patients treated with percutaneous coronary intervention (PCI); interpatient variation cannot be explained by poor initiation and persistence in these patients.

• Among MI patients without PCI and among MI patients with concomitant heart failure we found substantial underuse; therefore, focus on these groups is important.

AIMS

To identify possible underuse by analysing initiation and persistence with clopidogrel treatment in an unselected population of patients admitted with myocardial infarction (MI) with or without subsequent percutaneous coronary intervention (PCI).

METHODS

Patients admitted with first-time MI from 2000 to 2005 and subsequent prescription claims of clopidogrel were identified by individual-level linkage of nationwide administrative registries in Denmark. Independent factors affecting initiation and persistence with treatment were analysed by multivariable logistic regression models and Cox proportional hazard models.

RESULTS

A total of 46 190 MI patients were included in the study, of whom 14 939 were treated with PCI. From 2000 to 2005 initiation of clopidogrel increased from 80.4 to 93.7% among MI patients with PCI and from 2.8 to 39.3% among MI patients without PCI. MI patients with concomitant heart failure received less treatment [odds ratio (OR) 0.49, confidence interval (CI) 0.43, 0.56 among patients with PCI and OR 0.90, CI 0.81, 0.99 among patients without PCI in 2002–2003, and OR 0.89, CI 0.80, 1.00 in 2004–2005, respectively]. Of MI patients with PCI, 77.5% completed 9 months' clopidogrel treatment in 2004–2005, the corresponding figures for MI patients without PCI being 53.9%.

CONCLUSIONS

Initiation and persistence with clopidogrel treatment is high in MI patients with PCI. However, we found substantial underuse among MI patients without PCI and in MI patients with heart failure.

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