Predictors and Outcomes of Secondary Prevention Medication in Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Abstract

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.