Sex Disparity of DAPT Noncompliance in Patients with Left Main Stem PCI with DES

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2024 Jun 28

PMID 38941403

Authors

Malik Faisal Iftikhar

Muhammad Omer Rehman Rana

Ather Naeem

Muhammad Saad Waqas

Malik Hasnat Ul Hassan Khan

Umer Khiyam

Waheed Akhtar

Amin Mehmoodi

Jahanzeb Malik

Affiliations

Soon will be listed here.

Abstract

This retrospective study aims to explore the sex disparity in dual antiplatelet therapy (DAPT) noncompliance among left main stem percutaneous coronary intervention (PCI) patients with drug-eluting stent (DES) and identify predictors associated with non-adherence. Data were collected from the medical records of 1585 patients, including 1104 males and 481 females, who underwent left main stem PCI with DES. Baseline characteristics, angiographic features, and DAPT compliance rates at 1 month and 12 months were analyzed. Univariate logistic regression was used to identify predictors of DAPT noncompliance. The overall DAPT noncompliance rate at 1 month was 8.5%, increasing to 15.5% at 12 months. Females exhibited slightly higher noncompliance rates than males at both 1 month (15.6% vs 14.5%) and 12 months (28.1% vs 19.0%), although the difference was not statistically significant. Smoking status showed a modest impact on non-adherence, with current smokers exhibiting a lower noncompliance rate (14.9% at 1 month). Prior coronary artery disease history was associated with increased noncompliance at 12 months (18.9%). Angiographic characteristics, including lesion location and Syntax score, had no consistent association with DAPT noncompliance. This study highlights sex disparity in DAPT noncompliance among patients undergoing left main stem PCI with DES. Comorbidities, socioeconomic status, smoking status, and prior coronary artery disease history were identified as predictors of non-adherence.

References

Krass I, Schieback P, Dhippayom T . Adherence to diabetes medication: a systematic review. Diabet Med. 2014; 32(6):725-37. DOI: 10.1111/dme.12651. View

Kefale B, Tadesse Y, Alebachew M, Engidawork E . Management practice, and adherence and its contributing factors among patients with chronic kidney disease at Tikur Anbessa Specialized Hospital: A hospital-based cross-sectional study. PLoS One. 2018; 13(7):e0200415. PMC: 6059431. DOI: 10.1371/journal.pone.0200415. View

Mechta Nielsen T, Frojk Juhl M, Feldt-Rasmussen B, Thomsen T . Adherence to medication in patients with chronic kidney disease: a systematic review of qualitative research. Clin Kidney J. 2018; 11(4):513-527. PMC: 6070096. DOI: 10.1093/ckj/sfx140. View

McGovern A, Tippu Z, Hinton W, Munro N, Whyte M, de Lusignan S . Comparison of medication adherence and persistence in type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab. 2017; 20(4):1040-1043. DOI: 10.1111/dom.13160. View

Rivera E, Clark-Cutaia M, Schrauben S, Townsend R, Lash J, Hannan M . Treatment Adherence in CKD and Support From Health care Providers: A Qualitative Study. Kidney Med. 2022; 4(11):100545. PMC: 9630784. DOI: 10.1016/j.xkme.2022.100545. View

Mehran R, Baber U, Steg P, Ariti C, Weisz G, Witzenbichler B . Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet. 2013; 382(9906):1714-22. DOI: 10.1016/S0140-6736(13)61720-1. View

Chen S, Lee W, Liang T, Liao I . Factors associated with gender differences in medication adherence: a longitudinal study. J Adv Nurs. 2014; 70(9):2031-2040. DOI: 10.1111/jan.12361. View

Sharma R, Kumar P, Prashanth S, Belagali Y . Dual Antiplatelet Therapy in Coronary Artery Disease. Cardiol Ther. 2020; 9(2):349-361. PMC: 7584687. DOI: 10.1007/s40119-020-00197-0. View

Fernandez-Lazaro C, Adams D, Fernandez-Lazaro D, Garcia-Gonzalez J, Caballero-Garcia A, Miron-Canelo J . Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Res Social Adm Pharm. 2018; 15(6):744-753. DOI: 10.1016/j.sapharm.2018.09.006. View

10.

Ashfaq F, Noor T, Ashraf S, Sohail H, Malik J, Ashraf A . Social Determinants of Clinical Visits After Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting. Curr Probl Cardiol. 2023; 48(8):101722. DOI: 10.1016/j.cpcardiol.2023.101722. View

11.

Bundhun P, Yanamala C, Huang F . Should a prolonged duration of dual anti-platelet therapy be recommended to patients with diabetes mellitus following percutaneous coronary intervention? A systematic review and meta-analysis of 15 studies. BMC Cardiovasc Disord. 2016; 16(1):161. PMC: 5006559. DOI: 10.1186/s12872-016-0343-y. View

12.

Clifford S, Perez-Nieves M, Skalicky A, Reaney M, Coyne K . A systematic literature review of methodologies used to assess medication adherence in patients with diabetes. Curr Med Res Opin. 2014; 30(6):1071-85. DOI: 10.1185/03007995.2014.884491. View

13.

Kheiri B, Simpson T, Osman M, Golwala H, Radaideh Q, Kumar K . Safety and efficacy of short-term (1 to 3 months) dual antiplatelet therapy in patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials. J Thromb Thrombolysis. 2020; 50(4):867-873. DOI: 10.1007/s11239-020-02069-9. View

14.

Yu J, Baber U, Mastoris I, Dangas G, Sartori S, Steg P . Sex-Based Differences in Cessation of Dual-Antiplatelet Therapy Following Percutaneous Coronary Intervention With Stents. JACC Cardiovasc Interv. 2016; 9(14):1461-9. DOI: 10.1016/j.jcin.2016.04.004. View

15.

Short S, Mollborn S . Social Determinants and Health Behaviors: Conceptual Frames and Empirical Advances. Curr Opin Psychol. 2015; 5:78-84. PMC: 4511598. DOI: 10.1016/j.copsyc.2015.05.002. View

16.

Choi Y, Park J, Kim U, Lee S, Son J, Shin D . Changes in smoking behavior and adherence to preventive guidelines among smokers after a heart attack. J Geriatr Cardiol. 2013; 10(2):146-50. PMC: 3708054. DOI: 10.3969/j.issn.1671-5411.2013.02.006. View

17.

Fleming L, Agnew S, Peddie N, Crawford M, Dixon D, MacPherson I . The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A quantitative systematic review. Breast. 2022; 64:63-84. PMC: 9130570. DOI: 10.1016/j.breast.2022.04.010. View

18.

Shlofmitz E, Shlofmitz R, Lee M . The Role of Novel Oral Anticoagulants and Antiplatelet Therapy after Percutaneous Coronary Intervention: Individualizing Therapy to Optimize Outcomes. Korean Circ J. 2019; 49(8):645-656. PMC: 6675700. DOI: 10.4070/kcj.2019.0185. View

19.

Sapkota S, Brien J, Greenfield J, Aslani P . A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes--impact on adherence. PLoS One. 2015; 10(2):e0118296. PMC: 4339210. DOI: 10.1371/journal.pone.0118296. View

20.

Malik J, Yousaf H, Abbasi W, Hameed N, Mohsin M, Shahid A . Incidence, predictors, and outcomes of DAPT non-compliance in planned vs. ad hoc PCI in chronic coronary syndrome. PLoS One. 2021; 16(7):e0254941. PMC: 8284673. DOI: 10.1371/journal.pone.0254941. View