About a third of patients didn’t fill their clopidogrel prescriptions for 3 or more days after undergoing a stent procedure, which was associated with twice the rate of mortality or a second heart attack, or as much as 5 times the risk in the first 30 days after the procedure, a study found.
Researchers in British Columbia reviewed hospital administrative, community pharmacy, and cardiac revascularization data for all patients who received a coronary stent from 2004 through 2006 with follow‐up out to 2 years. Bare metal stents (BMS) and drug-eluding stents (DES) were included.
Results appeared in the Journal of the American Heart Association.
Thirty percent of patients who received a DES and 31% of patients who received a BMS failed to fill a prescription within 3 days of discharge (median, 1 day; interquartile range, 1 to 3). This was predictive of mortality (DES: HR=2.4; 95% CI, 1.7 to 3.4; and HR=2.0; 95% CI, 1.5 to 2.7) and recurrent myocardial infarction (MI) (BMS: HR=2.2; 95% CI, 1.9 to 2.6; and HR=1.8; 95% CI, 1.5 to 2.1). This excess hazard was greatest in the 30‐day period immediately after hospital discharge (mortality: HR=5.5; 95% CI, 3.5 to 8.6; and MI: HR=3.1; 95% CI, 2.4 to 4.0, for all patients).
Patients who never filled a prescription for clopidogrel were at greatest risk of death (HR=12.0; 95% CI, 7.2 to 19.9; for DES and HR=5.1; 95% CI, 4.0 to 6.6; for BMS), compared with patients who delayed by more than 3 days (HR=1.7; 95% CI, 1.2 to 2.5; for DES and HR=1.8; 95% CI, 1.5 to 2.1; for BMS).
“Consistent with previous work, this delay was associated with an increase in mortality and recurrent hospital admission for MI over the study period,” the authors wrote. “Importantly, this delay was associated with a ~3‐fold greater excess hazard in the 30 days immediately after hospital discharge than during long‐term follow‐up out to 2 years.”