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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Acknowledgments
The authors appreciate all the investigators, clinical coordinators, and institutions involved in the JCD study.
Funding
This study was funded by SENSHIN Medical Research Foundation and Pfeizer Health Research Foundation.
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For the JCD-KICS Investigators. The Investigators are listed in Appendix.
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Appendix
Appendix
Investigators: Yohei Numasawa, Toshiki Kuno, Toshiyuki Takahashi (Ashikaga Red Cross Hospital), Yutaka Okada (Eiju General Hospital), Soushin Inoue, Iwao Nakamura (Hino Municipal Hospital), Shunsuke Takagi, Takashi Matsubara (Hiratsuka City Hospital), Masashi Takahashi, Keishu Li, Koichiro Sueyoshi (Kawasaki City Municipal Hospital), Taku Inohara, Atsushi Anzai, Kentaro Hayashida, Takashi Kawakami, Hideaki Kanazawa, Takahide Arai, Shunsuke Yuasa, Jun Fujita, Yuichiro Maekawa, Akio Kawamura (Keio University School of Medicine), Masahiro Suzuki (National Hospital Organization Saitama National Hospital) Yukinori Ikegami, Yukihiko Momiyama (National Hospital Organization Tokyo Medical Center), Ayaka Endo, Taku Hasegawa, Toshiyuki Takahashi, Susumu Nakagawa (Saiseikai Central Hospital), Takashi Yagi, Kenichiro Shimoji, Sonhan Yun, Takeshi Onitsuka, Shigetaka Noma (Saiseikai Utsunomiya Hospital), Yuji Nagatomo, Shiro Ishikawa (Saitama City Hospital), Atsushi Mizuno, Yutaro Nishi (St Luke’s International Hospital Heart Center), Masaru Shibata, Takashi Koyama (Tachikawa Kyosai Hospital), Kimi Koide, Yoshinori Mano, Takahiro Oki (Tokyo Dental College Ichikawa General Hospital), Daisuke Shinmura, Kouji Negishi (Yokohama Municipal Citizens Hospital).
Clinical Coordinators: Junko Susa, Ayano Ishikawa, Hiroaki Nagayama, Miho Umemura, Itsuka Saito,Kiri Shimauchi, Sachiko Koike, and Ikuko Ueda.
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Endo, A., Kohsaka, S., Miyata, H. et al. Disparity in the Application of Guideline-Based Medical Therapy after Percutaneous Coronary Intervention: Analysis from the Japanese Prospective Multicenter Registry. Am J Cardiovasc Drugs 13, 103–112 (2013). https://doi.org/10.1007/s40256-013-0021-8
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DOI: https://doi.org/10.1007/s40256-013-0021-8