Cardiovascular medication use following percutaneous coronary intervention: the Australian experience

Abstract

Aims: Despite the guidelines, a "treatment gap" exists in the delivery of pharmacotherapy for secondary prevention. We aimed to analyze the trend in guideline-based medication usage following percutaneous coronary intervention (PCI) using the Melbourne Interventional Group (MIG) registry over a 6-year period (2005-2010).

Methods: The MIG registry prospectively collects demographical, clinical, and procedural characteristics of consecutive patients undergoing PCI. We assessed medication use (aspirin, clopidogrel, ACE inhibitors, angiotensin receptor blockers, beta-blockers, and lipid-lowering agents) at 30 days and 12 months in patients alive and able to provide the information.

Results: The cohort consists of 12,813 patients who underwent 14,787 consecutive interventional procedures. They comprised 76% males: 22% were elderly (≥75 years), 23% had diabetes, 2% had severe renal impairment, 2% had severe left ventricular dysfunction, 26% presented with STEMI, and 44% of patients received drug-eluting stent. Follow-up was complete for 97.8% of the cohort at 30 days (2.2% mortality) and 89.1% at 12 months (4% mortality). From 2005 to 2010, the percentage of patients taking all five classes of medications increased each year. In 2010 at 30 days, nearly 60% of patients took all five classes of medications, and by 12 months, 75% of patients were taking four or five classes of medications.

Conclusion: In conclusion, while the increasing use of cardiovascular medicines in an "at-risk" Australian cohort is encouraging, a treatment gap appears to still exist.

Keywords: Guidelines; Medications; Percutaneous coronary intervention; Registry.