The impact of age and chronic kidney disease on secondary prevention post-primary percutaneous coronary intervention

Area of Science:

• Cardiology
• Pharmacology
• Nephrology

Background:

• Elderly patients and those with chronic kidney disease (CKD) historically receive suboptimal secondary prevention after myocardial infarction (MI).
• Contemporary data on secondary prevention in these vulnerable populations following primary percutaneous coronary intervention (PPCI) are limited.

Purpose of the Study:

• To evaluate the impact of age and CKD on the utilization of evidence-based secondary prevention therapies in patients undergoing PPCI for ST-elevation MI.
• To assess prescribing patterns at discharge and follow-up.

Main Methods:

• A cohort of 1169 consecutive patients undergoing PPCI for ST-elevation MI across five UK centers was studied.
• Secondary prevention medication use at discharge was assessed based on age (<60, 60-75, >75 years) and estimated glomerular filtration rate (eGFR).
• Prescribing practices were re-evaluated at 6 weeks post-PPCI in 567 patients.

Main Results:

• Patients over 75 years received fewer secondary prevention drugs (beta-blockers, ACE inhibitors/ARBs, statins) at discharge compared to younger patients (P < 0.01).
• In patients with CKD (eGFR < 60 ml/min/1.73 m²), use of ACE inhibitors/ARBs was lower at discharge (83.5%) and 6 weeks (77.5%) compared to those with eGFR > 60 ml/min/1.73 m² (95% and 92%, respectively).
• A slight decrease in medication use was observed by 6 weeks post-PPCI, particularly for beta-blockers and statins in the >75 years group.

Conclusions:

• Secondary prevention medication uptake is generally high following PPCI in the UK, even in elderly patients and those with renal dysfunction.
• Despite high initial uptake, there is a need for strategies to improve drug up-titration and ensure continued adherence post-discharge, especially in older patients and those with CKD.