Disparity in the application of guideline-based medical therapy after percutaneous coronary intervention

Analysis from the japanese prospective multicenter registry

Ayaka Endo, Shun Kosaka, Hiroaki Miyata, Akio Kawamura, Shigetaka Noma, Masahiro Suzuki, Takashi Koyama, Shiro Ishikawa, Yukihiko Momiyama, Susumu Nakagawa, Koichiro Sueyoshi, Shunsuke Takagi, Toshiyuki Takahashi, Yuji Sato, Satoshi Ogawa, Keiichi Fukuda

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Despite the known benefits of evidence-based medical care in patients with coronary artery disease, disparities exist in the application of guideline-based medical therapy (GBMT) after percutaneous coronary intervention (PCI), particularly in patients who have undergone revascularization procedures. Underestimation of risk, overestimation of side effects, and preference of the treating physician to prioritize invasive procedures may all affect the prescription pattern. Objective: We sought to describe how GBMT is prescribed after PCI in Japan. Methods: From September 2008 to 2010, 1,612 patients underwent PCI with stenting at 14 Japanese hospitals participating in the Japanese Cardiovascular Database Registry. GBMT was defined as treatment including dual antiplatelet therapy, beta-adrenoceptor antagonists (beta-blockers) and/or calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and statins. Results: Overall, 749 patients (46.5 %) were discharged on GBMT. Notably, the prescription rate of GBMT became lower with age (e.g. from 50.3 % [age 50-59 years] to 35.9 % [age over 80 years]). In addition, patients presenting with acute coronary syndrome (ACS) tended to receive GBMT more frequently (ST-segment elevation myocardial infarction [STEMI] 33.8 vs. 18.3 %; p < 0.001; non-ST-segment elevation myocardial infarction [NSTEMI] 8.5 vs. 5.9 %; p = 0.042), whereas patients presenting with cardiogenic shock (CS) had lower prescription rates of GBMT (2.1 vs. 4.1 %; p = 0.032). Overall age (odds ratio [OR] 0.647; p = 0.020), as well as the acute and emergent presentation (OR 3.229; p < 0.001 for STEMI; OR 2.122; p < 0.001 for NSTEMI; OR 0.35; p = 0.002 for CS) were also associated with prescription of GBMT. Conclusion: Only about half of the post-PCI patients were discharged on ideal GBMT. Elderly patients and those presenting with non-ACS status or hemodynamic compromise tended not to receive GBMT, and required more attention for optimization of their care.

Original languageEnglish
Pages (from-to)103-112
Number of pages10
JournalAmerican Journal of Cardiovascular Drugs
Volume13
Issue number2
DOIs
Publication statusPublished - 2013 Apr

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Percutaneous Coronary Intervention
Registries
Guidelines
Prescriptions
Therapeutics
Odds Ratio
Cardiogenic Shock
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Calcium Channel Blockers
Acute Coronary Syndrome
Angiotensin-Converting Enzyme Inhibitors
Adrenergic Receptors
Coronary Artery Disease
Patient Care
Japan
Hemodynamics
Myocardial Infarction
Databases
Physicians

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Disparity in the application of guideline-based medical therapy after percutaneous coronary intervention : Analysis from the japanese prospective multicenter registry. / Endo, Ayaka; Kosaka, Shun; Miyata, Hiroaki; Kawamura, Akio; Noma, Shigetaka; Suzuki, Masahiro; Koyama, Takashi; Ishikawa, Shiro; Momiyama, Yukihiko; Nakagawa, Susumu; Sueyoshi, Koichiro; Takagi, Shunsuke; Takahashi, Toshiyuki; Sato, Yuji; Ogawa, Satoshi; Fukuda, Keiichi.

In: American Journal of Cardiovascular Drugs, Vol. 13, No. 2, 04.2013, p. 103-112.

Research output: Contribution to journalArticle

Endo, A, Kosaka, S, Miyata, H, Kawamura, A, Noma, S, Suzuki, M, Koyama, T, Ishikawa, S, Momiyama, Y, Nakagawa, S, Sueyoshi, K, Takagi, S, Takahashi, T, Sato, Y, Ogawa, S & Fukuda, K 2013, 'Disparity in the application of guideline-based medical therapy after percutaneous coronary intervention: Analysis from the japanese prospective multicenter registry', American Journal of Cardiovascular Drugs, vol. 13, no. 2, pp. 103-112. https://doi.org/10.1007/s40256-013-0021-8
Endo, Ayaka ; Kosaka, Shun ; Miyata, Hiroaki ; Kawamura, Akio ; Noma, Shigetaka ; Suzuki, Masahiro ; Koyama, Takashi ; Ishikawa, Shiro ; Momiyama, Yukihiko ; Nakagawa, Susumu ; Sueyoshi, Koichiro ; Takagi, Shunsuke ; Takahashi, Toshiyuki ; Sato, Yuji ; Ogawa, Satoshi ; Fukuda, Keiichi. / Disparity in the application of guideline-based medical therapy after percutaneous coronary intervention : Analysis from the japanese prospective multicenter registry. In: American Journal of Cardiovascular Drugs. 2013 ; Vol. 13, No. 2. pp. 103-112.
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abstract = "Background: Despite the known benefits of evidence-based medical care in patients with coronary artery disease, disparities exist in the application of guideline-based medical therapy (GBMT) after percutaneous coronary intervention (PCI), particularly in patients who have undergone revascularization procedures. Underestimation of risk, overestimation of side effects, and preference of the treating physician to prioritize invasive procedures may all affect the prescription pattern. Objective: We sought to describe how GBMT is prescribed after PCI in Japan. Methods: From September 2008 to 2010, 1,612 patients underwent PCI with stenting at 14 Japanese hospitals participating in the Japanese Cardiovascular Database Registry. GBMT was defined as treatment including dual antiplatelet therapy, beta-adrenoceptor antagonists (beta-blockers) and/or calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and statins. Results: Overall, 749 patients (46.5 {\%}) were discharged on GBMT. Notably, the prescription rate of GBMT became lower with age (e.g. from 50.3 {\%} [age 50-59 years] to 35.9 {\%} [age over 80 years]). In addition, patients presenting with acute coronary syndrome (ACS) tended to receive GBMT more frequently (ST-segment elevation myocardial infarction [STEMI] 33.8 vs. 18.3 {\%}; p < 0.001; non-ST-segment elevation myocardial infarction [NSTEMI] 8.5 vs. 5.9 {\%}; p = 0.042), whereas patients presenting with cardiogenic shock (CS) had lower prescription rates of GBMT (2.1 vs. 4.1 {\%}; p = 0.032). Overall age (odds ratio [OR] 0.647; p = 0.020), as well as the acute and emergent presentation (OR 3.229; p < 0.001 for STEMI; OR 2.122; p < 0.001 for NSTEMI; OR 0.35; p = 0.002 for CS) were also associated with prescription of GBMT. Conclusion: Only about half of the post-PCI patients were discharged on ideal GBMT. Elderly patients and those presenting with non-ACS status or hemodynamic compromise tended not to receive GBMT, and required more attention for optimization of their care.",
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T1 - Disparity in the application of guideline-based medical therapy after percutaneous coronary intervention

T2 - Analysis from the japanese prospective multicenter registry

AU - Endo, Ayaka

AU - Kosaka, Shun

AU - Miyata, Hiroaki

AU - Kawamura, Akio

AU - Noma, Shigetaka

AU - Suzuki, Masahiro

AU - Koyama, Takashi

AU - Ishikawa, Shiro

AU - Momiyama, Yukihiko

AU - Nakagawa, Susumu

AU - Sueyoshi, Koichiro

AU - Takagi, Shunsuke

AU - Takahashi, Toshiyuki

AU - Sato, Yuji

AU - Ogawa, Satoshi

AU - Fukuda, Keiichi

PY - 2013/4

Y1 - 2013/4

N2 - Background: Despite the known benefits of evidence-based medical care in patients with coronary artery disease, disparities exist in the application of guideline-based medical therapy (GBMT) after percutaneous coronary intervention (PCI), particularly in patients who have undergone revascularization procedures. Underestimation of risk, overestimation of side effects, and preference of the treating physician to prioritize invasive procedures may all affect the prescription pattern. Objective: We sought to describe how GBMT is prescribed after PCI in Japan. Methods: From September 2008 to 2010, 1,612 patients underwent PCI with stenting at 14 Japanese hospitals participating in the Japanese Cardiovascular Database Registry. GBMT was defined as treatment including dual antiplatelet therapy, beta-adrenoceptor antagonists (beta-blockers) and/or calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and statins. Results: Overall, 749 patients (46.5 %) were discharged on GBMT. Notably, the prescription rate of GBMT became lower with age (e.g. from 50.3 % [age 50-59 years] to 35.9 % [age over 80 years]). In addition, patients presenting with acute coronary syndrome (ACS) tended to receive GBMT more frequently (ST-segment elevation myocardial infarction [STEMI] 33.8 vs. 18.3 %; p < 0.001; non-ST-segment elevation myocardial infarction [NSTEMI] 8.5 vs. 5.9 %; p = 0.042), whereas patients presenting with cardiogenic shock (CS) had lower prescription rates of GBMT (2.1 vs. 4.1 %; p = 0.032). Overall age (odds ratio [OR] 0.647; p = 0.020), as well as the acute and emergent presentation (OR 3.229; p < 0.001 for STEMI; OR 2.122; p < 0.001 for NSTEMI; OR 0.35; p = 0.002 for CS) were also associated with prescription of GBMT. Conclusion: Only about half of the post-PCI patients were discharged on ideal GBMT. Elderly patients and those presenting with non-ACS status or hemodynamic compromise tended not to receive GBMT, and required more attention for optimization of their care.

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