Current medical management of stable coronary artery disease before and after elective percutaneous coronary
Amer K Ardati1, Bertram Pitt, Dean E Smith
1Division of Cardiovascular Medicine, University of Illinois, Chicago, IL, USA.
Insights
Optimal medical therapy is underused in patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD). Opportunities exist to improve treatment, especially statin use in women.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is not superior to optimal medical therapy.
- Appropriate medical therapy use in patients undergoing PCI for stable CAD requires further investigation.
Purpose of the Study:
- To evaluate the utilization of essential medical therapy in patients with stable CAD undergoing PCI.
- To identify disparities in medical therapy administration based on patient demographics and history.
Main Methods:
- A retrospective analysis of 60,386 patients who underwent PCI for stable CAD between 2004 and 2009.
- Defined essential medical therapy as specific medication regimens before and after PCI, excluding patients with contraindications.
- Assessed the use of aspirin, clopidogrel, statins, and beta-blockers (BBs).
Main Results:
- Essential medical therapy was administered to 53.0% of patients before PCI and 82.1% at discharge.
- High utilization of aspirin (98.3% post-PCI) and clopidogrel (97.3% post-PCI) was observed.
- Women and patients on dialysis were less likely to receive statin therapy at discharge (OR 0.74 and 0.68, respectively).
Conclusions:
- Medical therapy for stable CAD remains underutilized both before and after PCI.
- Significant disparities exist, with women being less likely to receive statin therapy post-PCI.
- There are substantial opportunities to optimize medical therapy in patients with stable CAD.
Background:
Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is not superior to optimal medical therapy. It remains unclear if patients who receive PCI for stable CAD are receiving appropriate medical therapy.
Methods:
We evaluated the medical management of 60,386 patients who underwent PCI for stable CAD between 2004 and 2009. We excluded patients with contraindications to aspirin, clopidogrel, statins, or β-blockers (BBs). We defined essential medical therapy of stable CAD as treatment with aspirin, statin, and BB before PCI and treatment with aspirin, clopidogrel, and statin after PCI.
Results:
Essential medical therapy was used in 53.0% of patients before PCI and 82.1% at discharge. Aspirin was used in 94.8% patients before PCI and 98.3% of after PCI. Statins were used in 69.5% of patients before PCI and 84.5% after PCI. β-Blockers were used in 72.8% of patients before PCI. Clopidogrel was used in 97.3% of patients after PCI. Patients with a history of myocardial infarction or revascularization before PCI had better medical therapy compared with patients without such a history (62.8% vs 34.3% [P < .001] before PCI and 83.6% vs 79.1% [P < .001] after PCI). After adjusting for confounders and clustering, women (odds ratio 0.74, 95% CI 0.71-0.78) and patients on dialysis (odds ratio 0.68, 95% CI 0.57-0.80) were less likely to receive a statin at discharge.
Conclusions:
Medical therapy remains underused before and after PCI for stable CAD. Women are less likely to receive statin therapy. There are significant opportunities to optimize medical therapy in patients with stable CAD.
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