Predictors and Outcomes of Secondary Prevention Medication in Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Tianyu Li; Xiaofang Tang; Ying Song; Yi Yao; Xueyan Zhao; Zhan Gao; Yuejin Yang; Runlin Gao; Bo Xu; Jinqing Yuan

doi:10.5334/gh.812

Predictors and Outcomes of Secondary Prevention Medication in Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Glob Heart. 2021 Dec 27;16(1):89. doi: 10.5334/gh.812. eCollection 2021.

Authors

Tianyu Li¹, Xiaofang Tang¹, Ying Song¹, Yi Yao¹, Xueyan Zhao¹, Zhan Gao¹, Yuejin Yang¹, Runlin Gao¹, Bo Xu¹, Jinqing Yuan¹

Affiliation

¹ Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, CN.

PMID: 35141130
PMCID: PMC8719473
DOI: 10.5334/gh.812

Abstract

Background: Evidence on factors associated with guideline-directed secondary prevention medication (GDPM) after percutaneous coronary intervention (PCI) and its effect on the prognosis of patients with coronary artery disease (CAD) is lacking in China.

Aims: To ascertain predictors of GDPM in real-world clinical practice and to assess the effect of GDPM on clinical outcomes.

Design: A retrospective cohort study.

Methods: Consecutive patients admitted to Fuwai Hospital between January 2013 and December 2013 were recruited. GDPM comprised aspirin, clopidogrel, statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin Ⅱ receptor blockers. The primary outcome was five-year major adverse cardiovascular event (MACE) (cardiac death, myocardial infarction [MI] and unplanned revascularization). Multivariable logistic regression was used to identify predictors of prescribing GDPM. Multivariable Cox regression was used to examine the relationship between GDPM and clinical outcomes.

Results: 10,067 patients were followed up for a median of 5.0 years (interquartile range: 4.3-5.2), 45.1% were prescribed with GDPM. Presenting with ST-segment elevation MI (adjusted OR = 3.252 [2.832-3.736]), prior MI (adjusted OR = 2.174 [1.948-2.425]), more stents implanted (adjusted OR = 1.063 [1.022-1.106]), overweight (adjusted OR = 1.136 [1.038-1.243]), obesity (adjusted OR = 1.274 [1.100-1.476]), diabetes (adjusted OR = 1.225 [1.115-1.344]), and hypertension (adjusted OR = 3.556 [3.196-3.956]) predicted the prescription of GDPM. Advanced age (adjusted OR = 0.556 [0.379-0.816]) was associated with lower prescription rate of GDPM. Patients with GDPM had lower rate of 5-year MACE (adjusted HR = 0.889 [0.808-0.978]) relative to those without GDPM.

Conclusions: Despite the benefit of GDPM in improving the prognosis of CAD patients undergoing PCI, gaps still exist in GDPM prescription in real-world clinical practice. Our study determined target populations for physicians to strive to promote the application of GDPM.

Keywords: Secondary prevention medication; coronary artery disease; guideline adherence; percutaneous coronary intervention; prognosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Disease* / epidemiology
Coronary Artery Disease* / surgery
Humans
Percutaneous Coronary Intervention* / adverse effects
Retrospective Studies
ST Elevation Myocardial Infarction*
Secondary Prevention
Treatment Outcome

Grants and funding

National Key Research and Development Program of China (No. 2016YFC1301301). National Natural Science Foundation of China (No. 81770365).