Initiation And Persistence With Antiplatelet Agents Among The Patients With Acute Coronary Syndromes: A Retrospective, Observational Database Study In China

OBJECTIVES: To investigate the initiation and persistence of antiplatelet agents and the associated factors for patients with acute coronary syndromes (ACS) in Tianjin, China. METHODS: Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2011–2015). Adult patients who were discharged alive after the first ACS-related hospitalization (index hospitalization) between January 2012 and December 2014 were included. Patients who initiated with antiplatelet therapy, including aspirin monotherapy, clopidogrel monotherapy, or dual antiplatelet with aspirin and clopidogrel at discharge or within the initial 30-day follow-up after discharge were further identified. Patients with no gaps of ≥30 days in antiplatelet therapy were deemed persistent. The logistic model and Cox model were used to explore the associated factors of initiation and persistence with antiplatelet agents, respectively. RESULTS: In total, 21,450 patients (64.6±10.7 years; 46.0% female) were included. Only 70.3% (N=15,071) of them initiated with antiplatelet agents within the initial 30-day follow-up; 85.0% (N=12,809) of the initial users discontinued their antiplatelet therapy, and the average time to discontinuation was 117.4±119.7 days. The patients who had prior antiplatelet agents utilization (Odds ratio [95% CI]=1.93 [1.78–2.09]; hazard ratio [95% CI]=0.78 [0.74–0.81]), received percutaneous coronary intervention (PCI) during the baseline period (OR=1.47 [1.26–1.73]; HR=0.91 [0.84–0.97]) or index hospitalization (OR=22.40 [18.63–26.92]; HR=0.51 [0.49–0.53]) were more likely to initiate and persist with antiplatelet agents, while the female (OR=0.75 [0.70–0.81]; HR=1.22 [1.88–1.27]) patients were less likely to initiate and persist with antiplatelet agents. CONCLUSION: The initiation and persistence with antiplatelet agents are poor among the ACS patients in Tianjin. Females are associated with poorer initiation and persistence, while prior antiplatelet agents use and receiving PCI during baseline period or index hospitalization are associated with better initial use and better persistence.