GHOST: Accurate Medical History May Predict DAPT Adherence in PCI for STEMI

SAN FRANCISCO, CALIF.—Collecting an accurate medical history can predict adherence to dual antiplatelet therapy, and could therefore inform decisions regarding BMS vs. DES use in patients with STEMI, according to data presented at TCT 2011. During the study, physicians determined that the collection of medical histories was sufficient to predict adherence to DAPT in the majority of patients.

Maurizio Menichelli, MD, of the Spaziani Hospital in Frosinone, Italy, noted that a major concern with DES use in patients with STEMI is adherence to DAPT. Guidelines from the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery list difficulty in obtaining a clinical history in the setting of conditions such as STEMI and cardiogenic shock as a relative clinical contraindication to DES use. Menichelli said, however, that no clinical evidence supports this assertion.

To test the reasoning behind the relative contraindication, Menichelli and colleagues had a single physician obtain  medical histories before STEMI PCI and had a different physician collect  medical histories using the same standardized form 4 days after the index procedure.

“The aim of the study was to use evidence-based medicine to confirm or refute this hypothesis,” Menichelli said.

One hundred and twenty patients enrolled between July and December 2004 at four clinical sites in Italy. Both physicians were asked whether adherence to DAPT could be anticipated given the medical histories taken from the patients. At day 4, physicians determined that the medical histories were sufficient to predict adherence in the majority of patients.

Upon further stastistical analysis to assess agreement between physicians, in which a score higher than 0.81 indicated almost perfect agreement,the data yielded a score of 0.889, Menichelli reported, and after reclassification of one patient who had a language barrier, the kappa score rose to 0.913.

“In conclusion, the relative indication can be refuted and we can return to using BMS according to evidence-based medicine,” Menichelli said.

Regarding the choice of STEMI patients as the study population, “four days after the STEMI procedure, the patient is not receiving any drugs for pain; we have access to medical records; access to relatives; and we don’t have to rush to open the arteries,” Menichelli explained.

Disclosures:

Dr. Menichelli reports no relevant conflicts of interest.