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
Affiliations
Tianyu Li
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Xiaofang Tang
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Ying Song
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Yi Yao
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Xueyan Zhao
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Zhan Gao
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Yuejin Yang
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Runlin Gao
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Bo Xu
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
Jinqing Yuan
Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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.
