| Objective:Ticagrelor-related dyspnea may affect the medication adherence of patients with coronary artery disease(CAD).This study aims to investigate the contemporary use and determinants of persistence to ticagrelor,and assess the effect of switching from ticagrelor to clopidogrel on end point event rates in clinical practice.Methods:Patients with CAD in Fuwai hospital who discharged on ticagrelor between Jan.2015 to Jun.2015 were analyzed.The clinical characteristics and persistence to ticagrelor of these patients were collected by reviewing the electronic medical records and personnel interview.Follow-up was performed at 6 and 12 months by telephone interview or personnel contact.Results:559 patients with CAD were enrolled,of whom 427(76.4%)were male.The mean age(SD;range)was 57.5(9.9;30-90)years and the proportion of patients with age≥ 65 years and ≥ 75 years were 22.2%and 3.9%,respectively.The mean(SD)weight and BMI were 73.2(11.5)kg and 25.9(3.4),respectively.127(22.7%)patients have a history of myocardial infraction and 204(36.5%)have a history of percutameous coronary intervention(PCI).404(72.3%)were acute coronary syndrome(ACS)and 155(27.7%)stable coronary artery disease(SCAD).430(76.9%)patients had angiographic confirmed left main and/or multivessel disease.At 12 months,death from any cause,cardiovascular death,non-fatal myocardial infarction,or non-fatal stroke had occurred respectively in 1.3%,0.9%,0.5%or 0.7%of patients with CAD,repectively.3 patients(0.5%)had life-threatening bleeding and 1 patient(0.2%)other major bleeding.5 patients(0.9%)had minor bleeding and 194 patients(34.7%)minimal bleeding.Dyspnea occurred in 20 patients(3.6%).158 patients(39.1%)with ACS prematurely stopped ticagrelor within 12 months,while 119(29.5%)who switched from ticagrelor to clopidogrel.Unavailable locally,economic reasons and hemorrhagic events were the main causes of the premature discontinuation of ticagrelor.Univariate analysis showed left main disease(P=0.04)and the frequency of outpatient follow-up(P<0.01)as relative factors for early ticagrelor discontinuation after discharge.Multivariate analysis revealed that medical insurance payment(OR 2.10,95%CI 1.20～3.67)and low frequency of outpatient follow-up(OR 0.65,95%CI 0.46～0.92)were independent risk factors for prematurely stopping ticagrelor for ACS patients outside hospital.46 patients(29.7%)with SCAD prematurely stopped ticagrelor within 12 months,while 25(16.1%)who switched from ticagrelor to clopidogrel.Hemorrhagic events and unavailable locally were the main causes of the premature discontinuation of ticagrelor.Univariate analysis showed age(P=0.01),BMI(body mass index)(P=0.02),hypertention(P=0.01)and unavailable locally(P=0.04)as relative factors for early ticagrelor discontinuation after discharge.Multivariate analysis revealed unavailable locally(OR 0.25,95%CI 0.09～0.69)and elderly patients(OR 4.13,95%CI 1.40-12.19)were risk factors for low persientence or premature ticagrelor discontinuation.Among 404 patients with ACS treated with ticagrelor,109(27.0%)patients were switched to clopidogrel within 6 months after discharge.When compared with continuation on ticagrelor,switching from ticagrelor to clopidogrel within 1 month,2-3 month,or 4-6 month was not associated with increased all cause death(P=0.16),cardiovascular death(P=1.00),myocardial infarction(P=0.30)or stroke.Conclusion:Some patients with stable coronary artery disease received ticagrelor in the clinical practice.Ticagrelor is mostly used in young,high BMI and high risk patients with coronary artery disease.The medication persistence with ticagrelor after discharge is poor.Social conditions is the main factor for the persistence to ticagrelor among CAD patients after dischcrge.In patients with ACS after discharge,switching from ticagrelor to clopidogrel may be safe and not have impact on adverse cardiovascular events. |
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