Disparity in the application of guideline-based medical therapy after percutaneous coronary intervention: Analysis from the japanese prospective multicenter registry

Ayaka Endo, Shun Kohsaka, 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 journalArticlepeer-review

4 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 1

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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