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Application of evidence-based medical therapy is associated with improved outcomes after percutaneous coronary intervention and is a valid quality indicator.

Abstract：

OBJECTIVES:We sought to determine whether the prescription of evidence-based medications at discharge after successful percutaneous coronary intervention (PCI) can predict long-term clinical outcome. BACKGROUND:The association of standard-of-care drug utilization and long-term mortality and morbidity after PCI is not well studied. METHODS:We performed a retrospective cohort study of successful PCI procedures performed on 7,745 patients between March 1, 1998, and December 31, 2004. Discharge medications were analyzed, and a medication score (MEDS) was developed. A MEDS of 1 was assigned for each of the following medication classes: 1) antiplatelet, 2) lipid-lowering, 3) beta-blocker, and 4) angiotensin-converting enzyme (ACE) inhibitor. The outcomes measured were long-term death, myocardial infarction, and revascularization. RESULTS:Patients with MEDS of 3 to 4 had higher-risk profiles based upon standard clinical and angiographic criteria. Despite this, at a median follow-up of 36 months, patients with a MEDS of 3 or 4 were at lower risk of death than those with a MEDS of 0 or 1 (8.9%, 7.5%, and 13% for MEDS of 4, 3, and 0 to 1, respectively; p = 0.014). After adjustment for covariates, a MEDS of 3 to 4 was associated with significantly lower mortality or myocardial infarction in follow-up than a MEDS of 0 to 1 (hazard ratios of 0.72 and 0.67 for MEDS of 3 and 4, respectively; p < 0.01). There was no association between MEDS and target vessel revascularization. CONCLUSIONS:After successful PCI, the use of multiple evidence-based classes of cardiovascular medications--antiplatelet, lipid-lowering, beta-blockers, and ACE inhibitors--is associated with improved outcome free of death or MI.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Jaber WA,Lennon RJ,Mathew V,Holmes DR Jr,Lerman A,Rihal CS

doi

10.1016/j.jacc.2005.06.070

subject

Has Abstract

pub_date

2005-10-18 00:00:00

pages

1473-8

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(05)01770-5

journal_volume

pub_type

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Application of evidence-based medical therapy is associated with improved outcomes after percutaneous coronary intervention and is a valid quality indicator.