It has been shown that there are differences in outcomes in acute coronary syndromes due to income disparities. Antiplatelet therapy (aspirin and clopidogrel) is essential for preventing adverse outcomes after stent implantation. The cost of this treatment particularly clopidogrel may pose hindrance to compliance in low-income and uninsured population. It has been recommended that with the sirolimus-eluting stents the length of treatment with these antiplatelet agents is longer than conventional bare-metal stents. We looked at the compliance in different income populations who received sirolimus-eluting stents at a single-center registry.
The purpose of the study was to assess the non-compliance rate with the antiplatelet regimen in the insured population compared to uninsured low-income population and whether it was associated with recurrent hospitalizations, myocardial infarctions, or death. There are a total of 100 patients, who underwent sirolimus-eluting stent implantation, from April 2003 to October 2003 were followed at three months. It comprised of 50 patients in each socioeconomic arms from the registry of a single medical center.
The non-complaince rate with the antiplatelet therapy in insured versus uninsured low-income population is 2 patients (4%) versus 12 patients (24%) respectively at three months. All these patients were non-complaint to clopidogrel and one patient from the uninsured low-income population was non-complaint to aspirin as well. None of the patients from of the insured population were hospitalized or had myocardial infarction or death. One patient (2%) from the uninsured population had ST elevation myocardial infarction with stent thrombosis at 8 days and underwent successful revascularization. This patient was non-complaint to clopidogrel.
There is a significant incidence of non-complaince rate with antiplatelet regimen particularly clopidogrel among the low socioeconomic population due to cost issues.
Non-complaince to antiplatelet regimen is an important factor to consider prior to coronary intervention since stent thrombosis secondary to inadequate antiplatelet therapy has significant morbidity and mortality.
Anuj Agarwal, None.