Patterns and Intensity of Medical Therapy in Patients Undergoing Percutaneous Coronary Intervention

被引:137
作者
Borden, William B. [1 ,2 ]
Redberg, Rita F. [3 ]
Mushlin, Alvin I. [2 ]
Dai, David [4 ]
Kaltenbach, Lisa A. [4 ]
Spertus, John A. [5 ]
机构
[1] Cornell Univ, Weill Cornell Med Coll, Dept Med, New York, NY 10021 USA
[2] Cornell Univ, Weill Cornell Med Coll, Dept Publ Hlth, New York, NY 10021 USA
[3] Univ Calif San Francisco, Dept Med, San Francisco, CA USA
[4] Duke Univ, Duke Clin Res Inst, Durham, NC USA
[5] Univ Missouri, St Lukes Mid Amer Heart Inst, Kansas City, MO 64110 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2011年 / 305卷 / 18期
基金
美国医疗保健研究与质量局;
关键词
CARDIOVASCULAR-DATA-REGISTRY; ST-SEGMENT ELEVATION; ARTERY-DISEASE; MYOCARDIAL-INFARCTION; SECONDARY PREVENTION; PRACTICE GUIDELINES; QUALITY; CARE; PREVALENCE; TRENDS;
D O I
10.1001/jama.2011.601
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) study, which provided optimal medical therapy (OMT) to all patients and demonstrated no incremental advantage of percutaneous coronary intervention (PCI) on outcomes other than angina-related quality of life in stable coronary artery disease (CAD), suggests that a trial of OMT is warranted before PCI. It is unknown to what degree OMT is applied before PCI in routine practice or whether its use increased after the COURAGE trial. Objective To examine the use of OMT in patients with stable angina undergoing PCI before and after the publication of the COURAGE trial. Design, Setting, and Participants An observational study of patients with stable CAD undergoing PCI in the National Cardiovascular Data Registry between September 1, 2005, and June 30, 2009. Analysis compared use of OMT, both before PCI and at the time of discharge, before and after the publication of the COURAGE trial. Optimal medical therapy was defined as either being prescribed or having a documented contraindication to all medicines (antiplatelet agent, beta-blocker, and statin). Main Outcome Measures Rates of OMT before PCI and at discharge (following PCI) between the 2 study periods. Results Among all 467 211 patients (173 416 before [37.1%] and 293 795 after [62.9%] the COURAGE trial) meeting study criteria, OMT was used in 206 569 patients (44.2%; 95% confidence interval [CI], 44.1%-44.4%) before PCI and in 303 864 patients (65.0%; 95% CI, 64.9%-65.2%) at discharge following PCI (P<.001). Before PCI, OMT was applied in 75 381 patients (43.5%; 95% CI, 43.2%-43.7%) before the COURAGE trial and in 131 188 patients (44.7%; 95% CI, 44.5%-44.8%) after the COURAGE trial (P<.001). The use of OMT at discharge following PCI before and after the COURAGE trial was 63.5% (95% CI, 63.3%-63.7%) and 66.0% (95% CI, 65.8%-66.1%), respectively (P<.001). Conclusion Among patients with stable CAD undergoing PCI, less than half were receiving OMT before PCI and approximately two-thirds were receiving OMT at discharge following PCI, with relatively little change in these practice patterns after publication of the COURAGE trial. JAMA. 2011;305(18):1882-1889 www.jama.com
引用
收藏
页码:1882 / 1889
页数:8
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