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Early occurrence of drug intolerance as risk factor during follow up in patients with acute coronary syndrome or coronary revascularization.

Aims: The occurrence of drug intolerance (DI) after an acute coronary syndrome (ACS) or percutaneous coronary revascularization (PCI) is an important reason for quitting treatment. Nevertheless, the association between DI and major cardiac and cerebrovascular events (MACCE) is poorly reported in literature, therefore we analysed potential relationship between DI and MACCE (a composite of ACS, PCI, heart failure, stroke) during follow-up.

Methods and Results: From 1/1/2014 to 31/12/2015, 891 consecutive patients after ACS or coronary revascularization were referred to Cardiac Rehabilitation (CR) Program and included in a dedicated registry where DI was analysed and treatment appropriately tailored. 309 patients (34.7%) developed DI, 26.9% of them were female. ACE-Inhibitors and statins were the most frequent drugs which caused DI, followed by beta-blockers and calcium channel blockers, in 13.1%,12.8%, 7.5% and 5.5% of patients, respectively. During a median follow-up of 18 (IQR 11-24) months after CR, MACCE occurred in 14.1% of patients with DI and 8.1% without DI (p = 0.007). At multivariable model, DI to 1 drug (OR 1.8, CI 95% 1.01-3.18, p = 0.043) or to 2 drugs (OR 2.56, CI 95% 1.27-5.17, p = 0.008) were independently associated to MACCE. Regarding the association of specific class of prognostic drugs to MACCE, only DI to ACE-Inhibitors was independently associated with MACCE (OR 2.31, CI 95% 1.14-4.65, p = 0.019).

Conclusions: DI was frequently encountered in real word clinical practice and was significantly associated with MACCE during follow up. This study suggests that early occurrence of DI could be considered as an adjunctive cardiovascular risk factor during secondary prevention.

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