Cardiac Medication Use in Patients with Acute Myocardial Infarction and Nonobstructive Coronary Artery Disease
Falisha Adatia1, Shannon Galway1,2, Maja Grubisic3
11 Vancouver General Hospital , Vancouver, Canada .
Insights
Patients with myocardial infarction (MI) and nonobstructive coronary artery disease (CAD) receive cardiac medications less often than those with obstructive CAD. This highlights a need to improve medication adherence in nonobstructive CAD post-MI.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Patients with acute myocardial infarction (MI) and nonobstructive coronary artery disease (CAD) experience elevated cardiac event rates.
- This suggests a potential benefit from cardiac medication in this patient group.
Purpose of the Study:
- To evaluate cardiac medication use 3 months before and after angiography in MI patients with no CAD, nonobstructive CAD, and obstructive CAD.
- To examine sex differences in cardiac medication use post-angiography based on CAD extent.
Main Methods:
- A cohort of 3,841 MI patients aged ≥20 years undergoing coronary angiography in British Columbia (2008-2010) was studied.
- Medication use (ACE-Is, ARBs, CCBs, beta-blockers, statins, antiplatelets) was tracked via PharmaNet.
- Optimal Medical Therapy (OMT) was defined as use of ACE-Is/ARBs, beta-blockers, and statins.
Main Results:
- Patients with no CAD and nonobstructive CAD had significantly lower prescription rates for most cardiac medications compared to obstructive CAD patients post-angiography (p < 0.001).
- After adjustment, nonobstructive CAD patients were less likely to receive these medications, including OMT (OR=0.25; 95% CI: 0.18-0.36).
- No significant sex differences in medication use were observed 3 months post-angiography.
Conclusions:
- Post-MI medication use at 3 months is significantly lower in patients with nonobstructive CAD compared to those with obstructive CAD.
- While sex is not an independent predictor, future research should focus on improving medication use in nonobstructive CAD patients post-MI.
Importance:
Patients with acute myocardial infarction (MI) and nonobstructive coronary artery disease (CAD) have an elevated cardiac event rate, suggesting that these patients may benefit from cardiac medication.
Objective:
We evaluated the rates of cardiac medication use 3 months before angiography and 3 months following clinically indicated angiography for MI in patients with no CAD, nonobstructive CAD, and obstructive CAD. We also examined the sex differences in cardiac medication use 3 months following angiography in patients by extent of angiographic CAD.
Methods:
We studied patients ≥20 years old with MI undergoing coronary angiography in British Columbia, Canada, from January 1, 2008, to March 31, 2010 (n = 3,841). No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1% to 49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Medication use, 3 months before and 3 months following angiography, was obtained through British Columbia PharmaNet for angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, statins, and antiplatelet agents. Optimal medical therapy (OMT) was defined as filled prescriptions for all three: ACE-Is/ARBs, beta-blockers, and statins.
Results:
Following angiography, in all medication categories except CCBs, patients with no CAD and nonobstructive CAD had significantly lower rates of prescriptions filled than patients with obstructive CAD (all p < 0.001). After adjusting for age and prior medication use, patients with nonobstructive CAD were still less likely to receive these medications than patients with obstructive CAD, including OMT with an odds ratio = 0.25 (95% confidence interval: 0.18-0.36). There were no significant sex differences in medication use 3 months postangiography.
Conclusions:
In post-MI patients, medication use following angiography is significantly lower in nonobstructive CAD than obstructive CAD at 3 months. While sex was not an independent predictor of medication use 3 months post-catheterization, future studies should explore methods of improving medication use in both females and males with nonobstructive CAD post-MI.
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