Analysis Of Factors Influencing DAPT Compliance After PCI

Objective:To investigate the compliance and the influencing factors of dual antiplatelet therapy(DAPT)after percutaneous coronary intervention(PCI)in patients with stent implantation.Methods:Retrospectively collected and analyzed patients with coronary artery disease who underwent DAPT after PCI and stent implantation at the heart center of Hunan Provincial People’s Hospital between January 2015 and December 2015,collected complete medical records,at 12 months after PCI,the patient’s compliance with DAPT was investigated and evaluated through an outpatient questionnaire or a telephone follow-up,and initially understand the status of DAPT compliance after PCI,and summarize the reasons for the poor DAPT compliance.Patients were classified according to general demographic characteristics,and χ2 test was used to analyze the differences in DAPT compliance among patients with different demographic characteristics.On the basis of this,multivariate logistic regression analysis was used to analyze the factors affecting DAPT compliance.Finally,the differences in major adverse cardiovascular events(MACE)among patients with different adherences were evaluated.Results:Among the 916 patients who were effectively followed in the study,at the 12 months after PCI,there were 513 patients(56.0%)with good DAPT compliance and 403(44.0%)patients with poor DAPT compliance,including 112 patients(27.8%)had poor DAPT compliance due to the patient’s fear of side effects,208 patients had poor DAPT compliance due to their belief that there was no need to continue medication,and 32 patients had poor adherence to DAPT due to the use of traditional Chinese medicine or health supplements instead,19 patients had poor adherence to DAPT because of the high price of the drug,and 17 patients had poor adherence to DAPT due to drug side effects.15 patients had poor DAPT compliance due to doctor’s advice.Univariate analysis showed that the adherence rate of DAPT was higher in patients aged<62 than in patients with an age>62.The DAPT compliance rate of patients with relatively high educational level was significantly higher than that of patients with relatively low educational level.The DAPT compliance rate of patients with spouses was significantly higher than that of patients without spouses.TheDAPT compliance rates for publicly funded,medical insurance,and rural cooperative medical care patients were significantly higher than those for self-paying patients.The DAPT compliance rate of urban household registration patients was significantly higher than that of rural household registration patients.The DAPT compliance rate in patients with unstable angina and acute myocardial infarction was significantly higher than that in patients with stable angina pectoris.There was a statistically significant difference in the above comparison(P<0.05).However,there was no statistically significant difference in the level of DAPT compliance in terms of gender,risk factors,and number of lesions(P>0.05).Multivariate Logistic regression analysis showed that the age,education level,spouse status,and medical payment method of patients after PCI were independent factors that affected DAPT compliance(P<0.05).However,there was no significant correlation between DAPT compliance and the type of coronary heart disease and the family register.MACE statistics showed that the cumulative rate of MACE in patients with good compliance was 4.1%(21/516)during the 12-month follow-up period,including 3 cases of cardiac deaths,9 cases of non-fatal myocardial infarction,6 cases of revascularization,3 cases of coronary artery restenosis.The cumulative incidence of MACE in patients with poor compliance was 11.5%(47/408),including 5 cases of cardiac deaths,23 cases of non-fatal myocardial infarction,13 cases of revascularization,6 cases of coronaryartery restenosis.The incidence of MACE in patients with good DAPT compliance was significantly lower than those with poor DAPT compliance(P<0.05).Conclusion:1.In the 12-month follow-up period of PCI patients,the problem of poor adherence to DAPT was more serious and needs further improvement.2.The main reason for poor adherence to DAPT was that patients do not considered it necessary to take drugs and worried about drug side effects.3.During the 12-month follow-up period of patients undergoing PCI,DAPT compliance was significantly different among patients of different ages,education levels,spousal status,family register,medical payment methods,and coronary heart disease type.Among them,the higher the age and the lower the education level,the worse the compliance of DAPT.DAPT compliance was relatively poor in patients without spouse,household registration in rural areas,self-paying,and stable angina.The patient’s age,education level,medical payment method,and spouse status were significant factors affecting DAPT compliance.4.The cumulative incidence of MACE in patients with poor adherence to DAPT was higher.