A 58-year-old man with a history of hypertension, diabetes, and hyperlipidemia was admitted to the hospital because of a non-ST-segment elevation myocardial infarction. He underwent successful percutaneous coronary revascularization, including placement of a drug-eluting stent in his left circumflex artery. He was discharged on a regimen of aspirin, clopidogrel, metoprolol, lisinopril, and simvastatin.

One week following hospital discharge, the patient returned to work as a construction worker and was able to resume strenuous work without symptomatic limitations; however, 8 months later, he developed sudden chest pain while at work. The pain was similar in nature to what he experienced with his initial myocardial infarction (MI). He was taken to the hospital via ambulance, and a diagnosis of ST-segment elevation MI was made. The patient underwent primary percutaneous coronary intervention for thrombosis of the left circumflex artery stent. Discussions with the patient revealed that in the months following his initial MI, he became depressed because of marital problems and financial stress from having only intermittent work. He also said that it was not clear to him how long he needed to take all of the medications prescribed to him after his first MI. As a result, he cut back on his cardiac medications and recently stopped taking all of them, except aspirin.

This case report highlights the clinical scenario of recurrent cardiovascular events after stopping cardiac medications, reinforcing the importance of medication adherence. Whether the recurrent cardiac event is directly related to cessation of cardiac medications is unclear, but several studies support that cessation of certain medications (eg, beta blockers and oral antiplatelets such as clopidogrel) is associated with adverse outcomes. This case also shows that the first sign of medication nonadherence may be presentation with a secondary cardiac event; thus, an important clinical implication is the need to incorporate assessment of medication nonadherence into routine clinical practice. This would allow clinicians to potentially detect nonadherence before the occurrence of adverse events, enabling them to work with patients to develop solutions to help them with medication adherence.