Abstract

Background: Lack of education is associated with adverse outcomes following percutaneous coronary intervention (PCI). Whether or not this is due to medication non-compliance, which is a risk factor for cardiac events, is unclear. Methods: PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) is a multi-center, multinational, prospective registry of patients that have undergone stent implantation. The primary outcome is non-adherence to dual antiplatelet therapy (DAPT) defined as discontinuation, interruption, or disruption. Independently adjudicated outcomes were measured at 30 days after procedure. Discontinuation was defined as stopping DAPT because therapy was no longer needed, in contrast to interruption (stopping DAPT on under physician guidance because of a procedure or surgery), and disruption (stopping DAPT due to bleeding or non-compliance). Results: Among 5033 patients, the average age was 64 years, 74.5% were male, 40.9% presented with ACS, and 82% received a drug-eluting stent. At 30 days, the overall incidence of non-adherence was 2.1%. For either aspirin or thienopyridine, disruption occurred because of bleeding in 31.4% and because of non-compliance in 62.7%. There was a significant association between education level and overall non-adherence (p=0.006) (see table). A higher proportion of non-adherent patients achieved less than secondary education (22.3% vs.11.9%, p=0.0013) or secondary education (50.9% vs. 38.8%, p=0.016), while there was no significant difference in patients with higher levels of education. After adjusting for age, those who achieved university compared with less than secondary education had a lower risk of non-adherence (odds ratio 0.53, 95% confidence interval: 0.30-0.92, p=0.03). Conclusion: In this study, lower education levels were associated with non-adherence to DAPT within 30 days after PCI. This underlines the importance of patient education tools, especially for those with lower education status to enhance compliance in the real world.

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