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

Study Questions:

How useful is optimal medical therapy (OMT) in patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD), and how was it impacted by the COURAGE trial?

Methods:

The authors assessed the use of OMT before and after PCI in patients with stable CAD undergoing PCI in the NCDR® (National Cardiovascular Data Registry) between September 1, 2005, and June 30, 2009. They compared the use of OMT before and after publication of the COURAGE trial. OMT was defined as either being prescribed or having a documented contraindication to all medicines (antiplatelet agent, beta-blocker, and statin).

Results:

The study cohort was comprised of 467,211 patients, of whom 37.1% underwent PCI before and 293,795 (62.9%) underwent PCI after publication of the COURAGE trial. OMT was used in 44% of patients before PCI, and 65% of patients received it at discharge. There was only a slight change in use of OMT prior to PCI after the COURAGE trial (43.5% prior to COURAGE and 44.7% after COURAGE). The use of OMT after PCI increased from 63.5% to 66% in the time period following publication of the COURAGE trial.

Conclusions:

The authors concluded that OMT is markedly underutilized in patients with stable CAD.

Perspective:

This study demonstrates an immense gap in quality of care of patients with stable CAD. The underuse of OMT in such a large number of patients before and after PCI is concerning and invokes the need for dedicated quality improvement efforts to optimize the use of appropriate medical therapy.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease

Keywords: Registries, Coronary Artery Disease, Platelet Aggregation Inhibitors, Percutaneous Coronary Intervention, Drug Evaluation


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