(P-496) Association Between Persistence to Treatment After Percutaneous Coronary Intervention and Clinical Outcomes in Acute Coronary Syndrome Patients: A Multicenter Study in Indonesia

Background: Acute coronary syndrome (ACS) disease is a life-threatening condition and carries a high risk of recurring event. Persistence to treatment is known to reduce disease morbidity and mortality substantially. In this study, we focused on ACS patients undergoing their first percutaneous coronary intervention (PCI) to show the association between persistence to treatment and clinical outcomes. Similar studies have not been conducted in Indonesia yet.

Objectives: To investigate the association between persistence to treatment and clinical outcomes in patients with ACS after PCI

Methods: Hospital based, retrospective cohort study with 2 years follow-up was conducted with 367 patients. Patients were deemed as having persistence to treatment if the gap between prescriptions was ≤ 30 days. Persistence was assessed for cardiovascular drugs, namely antiplatelet drugs (WHO ATC code: B0A1C), lipid modifying agents (C10), and antihypertensive (C02, C03, C07, C08, C09). The clinical outcomes is re-hospitalization and major adverse cardiovascular and cerebrovascular events (MACCE), MACCE defined as a composite of repeat PCI, myocardial infarction, stroke, or all-cause death. The association between persistence to treatment and clinical outcomes was analyzed with logistic regression, adjusted for sex and age.

Results: In ACS patients who underwent their first PCI, there is a significant relationship between antiplatelet non-persistence and the incidence of repeat PCI (RR 3.09, 95% CI = 1.18-8.05). There is a significant relationship between non-persistence of lipid modifying agents and the incidence of MACCE (RR 2.07, 95% CI = 1.04-4.10), repeat PCI (RR 2.99, 95% CI = 1.14-7.85), and re-hospitalization (RR 1.78, 95% CI = 1.01-3.15). There is a significant relationship between non-persistence of antihypertensive with the incidence of MACCE (RR 1.94, 95% CI = 1.02-3.71) and repeat PCI (RR 2.68, 95% CI = 1.03-6.99).

Conclusions: Our study indicates that among ACS patients undergoing their first PCI, non-persistence to treatment may lead to worse clinical outcomes. Non-persistence to antiplatelet, lipid modifying agents, and antihypertensive drugs was associated with increased risk of repeat PCI. Non-persistence to lipid modifying agents and antihypertensive drugs is associated with higher risk of MACCE incidence, while non-persistence to lipid modifying agents therapy is also associated with higher risk of re-hospitalization.