†These authors contributed equally.
Academic Editor: Salvatore De Rosa
Background: Superiority of potent P2Y12 inhibitors over clopidogrel
after an acute coronary syndrome (ACS) has been well established, however potent
P2Y12 inhibition is responsible for more adverse events, which may influence
patient adherence to treatment. Aim of the present study is to investigate the
adherence to the prescribed P2Y12 inhibitor (P2Y12i) in patients on dual
antiplatelet therapy (DAPT) after an ACS. Methods: In an IDEAL-LDL trial
substudy, we included 344 patients after ACS discharged on DAPT. The primary
outcome was the difference between potent P2Y12i and clopidogrel in terms of
adherence, as well as other predictors of adherence to the antiplatelet regimen.
Secondary outcomes included the prevalence of DAPT continuation and its
predictors and the antiplatelet regimen selection after DAPT. Results:
Adherence to the potent P2Y12i and to clopidogrel was observed in 140/178
(78.7%) and 111/166 (66.9%) patients (p = 0.016), respectively. In the
multivariate model, after adjustment for P2Y12i switching during the first year
of therapy, there was no difference observed in adherence between potent P2Y12i
and clopidogrel (odds ratio [OR] = 0.98, 95% confidence interval [CI] =
0.55–1.74). Significant predictors included history of cardiovascular disease
(CVD) (OR = 0.51, 95% CI = 0.31–0.86) and percutaneous coronary intervention
(PCI) index event treatment (OR = 2.58, 95% CI = 1.38–4.82). Of patients, 72%
continued DAPT