Disparity in the Application of Guideline-Based Medical Therapy after Percutaneous Coronary Intervention: Analysis from the Japanese Prospective Multicenter Registry

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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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