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Effect of ticagrelor-related dyspnea on compliance with therapy in acute coronary syndrome patients

2014; Elsevier BV; Volume: 173; Issue: 1 Linguagem: Inglês

10.1016/j.ijcard.2014.02.028

1874-1754

Mélanie Gaubert, Marc Laine, Richard Toesca, Nathalie Fournier, Christophe Gramond, Jacques Bessereau, Z. Mokrani, Bruno Bultez, Virginie Chelini, Pierre Barnay, Luc Maillard, Franck Paganelli, Laurent Bonello,

Coronary Interventions and Diagnostics

Dual anti-platelet therapy is critical in preventing recurrent ischemic events in acute coronary syndrome (ACS) to prevent early stent thrombosis after percutaneous coronary intervention (PCI) [ 1 Yusuf S. Zhao F. Mehta S.R. et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001; 345: 494-502 Crossref PubMed Scopus (6016) Google Scholar , 2 Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) InvestigatorsEffects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001; 358: 527-533 Abstract Full Text Full Text PDF PubMed Scopus (3022) Google Scholar ]. Ticagrelor is a new P2Y12-receptor antagonist which overcomes most of the limitations of clopidogrel with a faster onset of action and a more intense and consistent platelet reactivity (PR) inhibition [ [3] Wallentin L. Becker R.C. Budaj A. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361: 1045-1057 Crossref PubMed Scopus (5465) Google Scholar ]. Accordingly, in the PLATO trial, ticagrelor was superior to clopidogrel in decreasing major adverse cardiac events (MACE) in the setting of ACS. In the PLATO trial, ticagrelor, which is issued from a new class of drug, was associated with a significantly higher incidence of dyspnea compared to clopidogrel. This original side effect may have contributed to the higher drug discontinuation rate observed in the ticagrelor group [ [3] Wallentin L. Becker R.C. Budaj A. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361: 1045-1057 Crossref PubMed Scopus (5465) Google Scholar ]. The impact of ticagrelor-related dyspnea on discontinuation and compliance in real world ACS patients has never been studied despite its potential impact on outcome. We therefore aimed to investigate in ACS patients undergoing PCI the impact of dyspnea on ticagrelor discontinuation and compliance during the first month following PCI.