Résumé
Premature discontinuation of antiplatelet therapy is a major risk factor of stent thrombosis after drug-eluting stent placement leading to an increased risk of death.
We sought to determine by a simple questionnaire the prevalence of patients at risk for premature discontinuation of oral antiplatelet therapy in elective percutaneous coronary intervention (PCI).
Patients scheduled for elective PCI underwent a routine interview (RI) and a specific questionnaire (SQ) by two independent physicians the day before the intervention. The SQ was designed to identify bleeding disorders, suspected cancer, planned invasive procedures and self evaluation of compliance. The final decision of drug eluting stent (DES) implantation was made by a third independent physician who performed the planned PCI and who had full access to the patient record.
At least one contraindication to DES implantation was found in one third of the study population (82/302, 27%) after the RI. All these patients were also identified by the SQ. At total of 31 additional patients were identified by the SQ as non eligible for DES implantation. Active bleeding (n = 14) and scheduled biopsies (n = 4) were the two main contraindications to DES implantation isolated by the SQ. Patients characteristics and angiographic findings identified 59.9% patients (n = 181/302) eligible for a DES implantation. Finally the physician performing the PCI excluded 66.3% of the patients (n = 79/302) who could receive a DES and implanted a bare metal stent (BMS) instead. This decision was based on the findings of the dedicated questionnaire on top of the interview in 30 patients (38%) and in 49 patients (62%) for other reasons.
In elective PCI, a simple questionnaire used before DES implantation can improve identification of patients at high risk for premature discontinuation of antiplatelet therapy.