Effects of Non-Adherence to Clopidogrel in Patients Undergoing Primary Percutaneous Coronary Intervention

Aims:Adherence to clopidogrel therapy is crucial for achieving favorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI). This prospective cohort study aimed to investigate the rates of clopidogrel adherence, factors associated with adherence, and clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: This study employed a prospective observational design involving patients diagnosed with myocardial infarction (MI) who were scheduled for percutaneous coronary intervention (PCI) and prescribed clopidogrel. Adherence to clopidogrel therapy was assessed, with follow-up visits scheduled at 30 days, 6 months, and 1 year post-intervention. Results: The study included 268 participants with a mean age of 58.9±13.2 years, predominantly male (82%). Adherence rates to clopidogrel were 94.8% at 1 month, 93% at 6 months, and 90.5% at 12 months post-PCI. The patients were compared in terms of adherence to clopidogrel. There were no significant differences in the distribution of sexes between the groups (p = 0.567). However, a significant difference in education levels was observed (p=0.034), with lower education levels associated with non-adherence. The non-adherence group had a higher risk of death (HR: 7.8, 95% CI: 6-106.8, p=0.001), cerebrovascular accident (HR: 10, 95% CI: 0.08-1.3, p=0.043), and major adverse cardiac and cerebrovascular events (MACCE) (HR: 5.2, 95% CI: 1.2-22.2, p=0.000). The primary factors contributing to non-adherence were low income (52%) and low health literacy (32%) among patients. Conclusion:Non-adherence to clopidogrel was associated with a heightened risk of adverse cardiovascular and cerebrovascular events in patients undergoing primary percutaneous coronary intervention for myocardial infarction.