Cardiovascular Medication Use Following Percutaneous Coronary Intervention: The Australian Experience

Abstract

SUMMARYAims: Despite the guidelines, a "treatment gap" exists in the delivery of pharmacotherapy for secondary prevention. We aimed to analyze the trend in guideline-based medication usage following percutaneous coronary intervention (PCI) using the Melbourne Interventional Group (MIG) registry over a 6-year period (2005)(2006)(2007)(2008)(2009)(2010). Methods: The MIG registry prospectively collects demographical, clinical, and procedural characteristics of consecutive patients undergoing PCI. We assessed medication use (aspirin, clopidogrel, ACE inhibitors, angiotensin receptor blockers, beta-blockers, and lipid-lowering agents) at 30 days and 12 months in patients alive and able to provide the information. Results: The cohort consists of 12,813 patients who underwent 14,787 consecutive interventional procedures. They comprised 76% males: 22% were elderly (≥75 years), 23% had diabetes, 2% had severe renal impairment, 2% had severe left ventricular dysfunction, 26% presented with STEMI, and 44% of patients received drug-eluting stent. Follow-up was complete for 97.8% of the cohort at 30 days (2.2% mortality) and 89.1% at 12 months (4% mortality). From 2005 to 2010, the percentage of patients taking all five classes of medications increased each year. In 2010 at 30 days, nearly 60% of patients took all five classes of medications, and by 12 months, 75% of patients were taking four or five classes of medications. Conclusion: In conclusion, while the increasing use of cardiovascular medicines in an "at-risk" Australian cohort is encouraging, a treatment gap appears to still exist.

Secondary CV Prevention in South America in a Community Setting: The PURE Study

“…jg SCIENCE lipid-lowering agents) [29]. In Chile, 1 year after MI discharge, medication utilization from 6 public hospitals was aspirin 93%, clopidogrel 33%, beta-blockers 66%, ACEI/ARB 73%, and statins 85% [30].…”

Evidence-based interventions in primary care following acute coronary syndrome in Australia and New Zealand: a systematic scoping review

“…One recent Australian observational study reported outcomes of patients ( n  = 12813) following a percutaneous coronary intervention (PCI), the majority in the context of ACS [26]. In 2010, 75 % of patients were taking ≥ 4 classes of drugs at 12 month follow-up.…”

“…Studies of medication prescription rates post-ACS report mostly high rates of antiplatelet therapy prescription [20, 26, 27, 31], with one study reporting an encouraging positive trend in medication prescription over time [26]. However, the prescription rates of other evidence-based medications demonstrate room for improvement, especially angiotensin-converting enzyme inhibitor/angiotensin-II receptor blockers (ACEi/ARBs) and glycerol trinitrate (GTN) spray [27, 28].…”

Predictors of permanent work disability among ≤50-year-old patients undergoing percutaneous coronary intervention

“…Based on the results, <50-year-old patients have an almost universal optimal medication at the time of hospital discharge from PCI. However, in general, 25-60% of patients discontinue optimal discharge medication one year after PCI (16)(17)(18). Moreover, young age in itself is a known predictor of both adverse events as well as poor adherence to secondary prevention (19,20).…”