Author + information
- Charles Resor,
- Alexander Turchin,
- Srikanth Reddy Devireddy,
- Eugene Pomerantsev,
- Gheorghe Doros and
- Laura Mauri
Background: Optimal medical therapy (OMT) and low density lipoprotein-C (LDL-C) management are cornerstones of secondary prevention of myocardial infarction. How current guideline recommendations for medical therapy and LDL-C management are implemented across patients with varying long term risks after percutaneous coronary intervention (PCI) is not well understood.
Methods: Among 8,893 consecutive patients undergoing PCI between 2009 and 2015 in the Partners Healthcare network, we examined patient and procedural characteristics and medication prescriptions and LDL-C levels. OMT at discharge was defined as a combination of aspirin, thienopyridine, statin, beta blocker and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) use in patients with an American College of Cardiology/American Heart Association class I indication for each medication. Goal LDL-C targets were defined as achieving LDL-C <70mg/dl or >50% reduction in LDL-C within the first year following PCI. Individual patient risk was characterized and stratified by quartile according to a long term ischemic risk model developed from the Dual Antiplatelet Therapy Study.
Results: Of 7,987 patients with complete data on discharge medications, 60.2% were discharged on all indicated medications. Rates of use on discharge for the individual classes of medications were: aspirin-99.0%, thienopyridine-98.5%, statin-88.0%, beta blocker-89.5% and ACE/ARB-66.8%. Patients in higher quartiles of ischemic risk were less likely to be discharged on OMT than those at lower risk (p=0.027). Of 3615 patients with data on LDL-C values, 61.5% achieved goal LDL-C targets. There was no significant linear correlation between achievement of OMT and LDL-C goals (Pearson correlation coefficient 0.006, p=0.733) as only 39.0% of patients achieved combined OMT and LDL-C goals. Patients in higher risk quartiles were less likely to achieve combined OMT and LDL-C goals than those in lower risk quartiles (p=.014).
Conclusions: Patients with elevated risks of future ischemic events were less likely to achieve combined OMT and LDL-C goals after PCI than those with lower risks of ischemic events.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1166-330
- 2017 American College of Cardiology Foundation