Current medical management of stable coronary artery disease before and after elective percutaneous coronary intervention

Amer K. Ardati, Bertram Pitt, Dean E. Smith, Herbert D. Aronow, David Share, Mauro Moscucci, Stanley Chetcuti, P. Michael Grossman, Hitinder S. Gurm

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is not superior to optimal medical therapy. It remains unclear if patients who receive PCI for stable CAD are receiving appropriate medical therapy. Methods We evaluated the medical management of 60,386 patients who underwent PCI for stable CAD between 2004 and 2009. We excluded patients with contraindications to aspirin, clopidogrel, statins, or β-blockers (BBs). We defined essential medical therapy of stable CAD as treatment with aspirin, statin, and BB before PCI and treatment with aspirin, clopidogrel, and statin after PCI. Results Essential medical therapy was used in 53.0% of patients before PCI and 82.1% at discharge. Aspirin was used in 94.8% patients before PCI and 98.3% of after PCI. Statins were used in 69.5% of patients before PCI and 84.5% after PCI. β-Blockers were used in 72.8% of patients before PCI. Clopidogrel was used in 97.3% of patients after PCI. Patients with a history of myocardial infarction or revascularization before PCI had better medical therapy compared with patients without such a history (62.8% vs 34.3% [P <.001] before PCI and 83.6% vs 79.1% [P <.001] after PCI). After adjusting for confounders and clustering, women (odds ratio 0.74, 95% CI 0.71-0.78) and patients on dialysis (odds ratio 0.68, 95% CI 0.57-0.80) were less likely to receive a statin at discharge. Conclusions Medical therapy remains underused before and after PCI for stable CAD. Women are less likely to receive statin therapy. There are significant opportunities to optimize medical therapy in patients with stable CAD.

Original languageEnglish
Pages (from-to)778-784
Number of pages7
JournalAmerican Heart Journal
Volume165
Issue number5
DOIs
StatePublished - May 1 2013

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Percutaneous Coronary Intervention
Coronary Artery Disease
Hydroxymethylglutaryl-CoA Reductase Inhibitors
clopidogrel
Aspirin
Therapeutics
Odds Ratio
Myocardial Revascularization
Cluster Analysis
Dialysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ardati, A. K., Pitt, B., Smith, D. E., Aronow, H. D., Share, D., Moscucci, M., ... Gurm, H. S. (2013). Current medical management of stable coronary artery disease before and after elective percutaneous coronary intervention. American Heart Journal, 165(5), 778-784. https://doi.org/10.1016/j.ahj.2013.01.015

Current medical management of stable coronary artery disease before and after elective percutaneous coronary intervention. / Ardati, Amer K.; Pitt, Bertram; Smith, Dean E.; Aronow, Herbert D.; Share, David; Moscucci, Mauro; Chetcuti, Stanley; Grossman, P. Michael; Gurm, Hitinder S.

In: American Heart Journal, Vol. 165, No. 5, 01.05.2013, p. 778-784.

Research output: Contribution to journalArticle

Ardati, AK, Pitt, B, Smith, DE, Aronow, HD, Share, D, Moscucci, M, Chetcuti, S, Grossman, PM & Gurm, HS 2013, 'Current medical management of stable coronary artery disease before and after elective percutaneous coronary intervention', American Heart Journal, vol. 165, no. 5, pp. 778-784. https://doi.org/10.1016/j.ahj.2013.01.015
Ardati, Amer K. ; Pitt, Bertram ; Smith, Dean E. ; Aronow, Herbert D. ; Share, David ; Moscucci, Mauro ; Chetcuti, Stanley ; Grossman, P. Michael ; Gurm, Hitinder S. / Current medical management of stable coronary artery disease before and after elective percutaneous coronary intervention. In: American Heart Journal. 2013 ; Vol. 165, No. 5. pp. 778-784.
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abstract = "Background Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is not superior to optimal medical therapy. It remains unclear if patients who receive PCI for stable CAD are receiving appropriate medical therapy. Methods We evaluated the medical management of 60,386 patients who underwent PCI for stable CAD between 2004 and 2009. We excluded patients with contraindications to aspirin, clopidogrel, statins, or β-blockers (BBs). We defined essential medical therapy of stable CAD as treatment with aspirin, statin, and BB before PCI and treatment with aspirin, clopidogrel, and statin after PCI. Results Essential medical therapy was used in 53.0{\%} of patients before PCI and 82.1{\%} at discharge. Aspirin was used in 94.8{\%} patients before PCI and 98.3{\%} of after PCI. Statins were used in 69.5{\%} of patients before PCI and 84.5{\%} after PCI. β-Blockers were used in 72.8{\%} of patients before PCI. Clopidogrel was used in 97.3{\%} of patients after PCI. Patients with a history of myocardial infarction or revascularization before PCI had better medical therapy compared with patients without such a history (62.8{\%} vs 34.3{\%} [P <.001] before PCI and 83.6{\%} vs 79.1{\%} [P <.001] after PCI). After adjusting for confounders and clustering, women (odds ratio 0.74, 95{\%} CI 0.71-0.78) and patients on dialysis (odds ratio 0.68, 95{\%} CI 0.57-0.80) were less likely to receive a statin at discharge. Conclusions Medical therapy remains underused before and after PCI for stable CAD. Women are less likely to receive statin therapy. There are significant opportunities to optimize medical therapy in patients with stable CAD.",
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AU - Ardati, Amer K.

AU - Pitt, Bertram

AU - Smith, Dean E.

AU - Aronow, Herbert D.

AU - Share, David

AU - Moscucci, Mauro

AU - Chetcuti, Stanley

AU - Grossman, P. Michael

AU - Gurm, Hitinder S.

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N2 - Background Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is not superior to optimal medical therapy. It remains unclear if patients who receive PCI for stable CAD are receiving appropriate medical therapy. Methods We evaluated the medical management of 60,386 patients who underwent PCI for stable CAD between 2004 and 2009. We excluded patients with contraindications to aspirin, clopidogrel, statins, or β-blockers (BBs). We defined essential medical therapy of stable CAD as treatment with aspirin, statin, and BB before PCI and treatment with aspirin, clopidogrel, and statin after PCI. Results Essential medical therapy was used in 53.0% of patients before PCI and 82.1% at discharge. Aspirin was used in 94.8% patients before PCI and 98.3% of after PCI. Statins were used in 69.5% of patients before PCI and 84.5% after PCI. β-Blockers were used in 72.8% of patients before PCI. Clopidogrel was used in 97.3% of patients after PCI. Patients with a history of myocardial infarction or revascularization before PCI had better medical therapy compared with patients without such a history (62.8% vs 34.3% [P <.001] before PCI and 83.6% vs 79.1% [P <.001] after PCI). After adjusting for confounders and clustering, women (odds ratio 0.74, 95% CI 0.71-0.78) and patients on dialysis (odds ratio 0.68, 95% CI 0.57-0.80) were less likely to receive a statin at discharge. Conclusions Medical therapy remains underused before and after PCI for stable CAD. Women are less likely to receive statin therapy. There are significant opportunities to optimize medical therapy in patients with stable CAD.

AB - Background Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is not superior to optimal medical therapy. It remains unclear if patients who receive PCI for stable CAD are receiving appropriate medical therapy. Methods We evaluated the medical management of 60,386 patients who underwent PCI for stable CAD between 2004 and 2009. We excluded patients with contraindications to aspirin, clopidogrel, statins, or β-blockers (BBs). We defined essential medical therapy of stable CAD as treatment with aspirin, statin, and BB before PCI and treatment with aspirin, clopidogrel, and statin after PCI. Results Essential medical therapy was used in 53.0% of patients before PCI and 82.1% at discharge. Aspirin was used in 94.8% patients before PCI and 98.3% of after PCI. Statins were used in 69.5% of patients before PCI and 84.5% after PCI. β-Blockers were used in 72.8% of patients before PCI. Clopidogrel was used in 97.3% of patients after PCI. Patients with a history of myocardial infarction or revascularization before PCI had better medical therapy compared with patients without such a history (62.8% vs 34.3% [P <.001] before PCI and 83.6% vs 79.1% [P <.001] after PCI). After adjusting for confounders and clustering, women (odds ratio 0.74, 95% CI 0.71-0.78) and patients on dialysis (odds ratio 0.68, 95% CI 0.57-0.80) were less likely to receive a statin at discharge. Conclusions Medical therapy remains underused before and after PCI for stable CAD. Women are less likely to receive statin therapy. There are significant opportunities to optimize medical therapy in patients with stable CAD.

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