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. 2025 Aug 9;25(1):595.
doi: 10.1186/s12872-025-05081-0.

Therapeutic inertia in statin therapy for secondary prevention after percutaneous coronary intervention: a nationwide population-based cohort study

Young-Hoon Seo #  1 , Jee-Young Hong #  2 , Yong-Kyun Kim  3 , Ki-Hong Kim  3 , Taek-Geun Kwon  4 , Jang-Ho Bae  3
Affiliations

Therapeutic inertia in statin therapy for secondary prevention after percutaneous coronary intervention: a nationwide population-based cohort study

Young-Hoon Seo et al. BMC Cardiovasc Disord. .

Abstract

Background: Therapeutic inertia is defined as the failure to provide guideline-directed therapy and is a barrier to achieving optimal clinical outcomes. We aimed to evaluate therapeutic inertia in statin therapy after percutaneous coronary intervention (PCI) and its association with patient characteristics and physician’s prescribing practice.

Methods: We analyzed the medical claims data on patients undergoing PCI using National Health Insurance Service in Republic of Korea. The primary outcome of interest was therapeutic inertia, defined as not providing high-intensity statin (HIS) therapy within 30 days after discharge for PCI. To identify statin use in identical clinical setting, we restricted study duration to between 2013 American College of Cardiology/American Heart Association cholesterol guideline and publications of RACING (Randomized Comparison of Efficacy and Safety of Lipid-lowering with Statin Monotherapy Versus Statin–ezetimibe Combination for High-risk Cardiovascular Disease) and LODESTAR (Low-Density Lipoprotein Cholesterol-Targeting Statin Therapy Versus Intensity-Based Statin Therapy in Patients With Coronary Artery Disease) trials that demonstrated non-inferiority of alternative statin strategies compared with HIS therapy in atherosclerotic cardiovascular disease. We also assessed patient characteristics affecting HIS prescription, statin switching before and after PCI among previous statin users, and impact of previous statin regimen on prescribing of HIS.

Results: Of 204,708 participants (mean age 66.5 ± 11.3 years, 30.8% female, 56.6% previous statin users, 43.4% previous statin nonusers), therapeutic inertia was identified in 64.1%, and HIS prescription rate was higher in previous statin nonusers (42.0%) than in previous statin users (31.1%). There were few differences in patient characteristics as positive (male and acute coronary syndrome as indication for PCI) and negative (increase of age, comorbidities, and cardiovascular medications) predictors of HIS prescription between previous statin users and nonusers. Because 79.1% of previous HIS users and 23.8% of previous non-HIS users received HIS following PCI, previous HIS users were more likely to be prescribed HIS as compared to previous statin nonusers (odds ratio, 5.42; 95% confidence intervals, 4.44–6.61) and previous non-HIS users (odds ratio, 12.30; 95% confidence intervals, 9.95–15.19).

Conclusions: Suboptimal HIS prescription following PCI was substantially affected by patient characteristics and the practice of repetitive prescribing of previous statin without guideline-directed titration.

Clinical trial number: Not applicable.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12872-025-05081-0.

Keywords: Cardiovascular disease; Coronary artery disease; Percutaneous coronary intervention; Secondary prevention; Statin; Therapeutic inertia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of Konyang University Hospital (2020-04-013) and requirement for written informed consents was waived because this study used anonymized and deidentified data. The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guideline and was performed in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trends in statin prescription after PCI. From the first half of 2014 through the second half of 2017, HIS prescription increased among both previous statin users (25.0–35.0%) (left) and previous statin nonusers (33.4–48.2%) (right) and non-HIS prescription decreased among both previous statin users (73.4–64.0%) and previous statin nonusers (61.0–47.9%). Ezetimibe use was rare through first half of 2016 and slightly increased thereafter. Abbreviations: HIS, high-intensity statin; PCI, percutaneous coronary intervention.
Fig. 2
Fig. 2
Switching statin before and after PCI among previous statin users. In previous HIS users, 79.1% were prescribed HIS after PCI, whereas 20.1% received non-HIS. In previous non-HIS users, 23.8% were prescribed HIS after PCI, whereas 74.8% received non-HIS. Statin switching of overall previous statin users were similar to that of previous non-HIS users because non-HIS accounted for a majority of statin used before PCI. Abbreviations: HIS, high-intensity statin; PCI, percutaneous coronary intervention
Fig. 3
Fig. 3
Temporal trends of HIS prescription after PCI according to previous statin use and intensity. The figure shows temporal trends in HIS prescription after PCI among previous HIS users, previous non-HIS users, and previous statin nonusers, which were calculated after excluding those who did not receive statin therapy after PCI in each populations. Abbreviations: HIS, high-intensity statin; PCI, percutaneous coronary intervention
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References

    1. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082–143. - PMC - PubMed
    1. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–88. - PubMed
    1. Rhee EJ, Kim HC, Kim JH, Lee EY, Kim BJ, Kim EM, et al. 2018 guidelines for the management of dyslipidemia in Korea. Korean J Intern Med. 2019;34(5):1171. - PMC - PubMed
    1. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American college of cardiology/american heart association task force on practice guidelines. Circulation. 2014;129(25 Suppl 2):S1–45. - PubMed
    1. Rodriguez F, Lin S, Maron DJ, Knowles JW, Virani SS, Heidenreich PA. Use of high-intensity Statins for patients with atherosclerotic cardiovascular disease in the veterans affairs health system: practice impact of the new cholesterol guidelines. Am Heart J. 2016;182:97–102. - PubMed

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