Abstract
Patients with known coronary artery disease rnay be receiving inadequate medical therapy prior to referral for percutaneous coronary revascularization. To examine the medical treatment of patients referred for percutaneous coronary revascularization, we analyzed pre-hospital treatment data and concomitant medical conditions from the CAVEAT I trial. Of the 1,012 patients referred for revascularization 68.3% had unstable angina, 17.6% had stable angina, 9.8% had chest pain after myocardial infarction, and 4.3% were asymptomatic with a positive functional study. Prior to PTCA or directional atherectomy (DCA), patients had low rates of treatment with aspirin, nitrates, calcium channel blockers, beta-blockers, and anti-lipid agents (Table). Pre-hospital medications were associated with the following conditions: aspirin-none, nitrates-none, calcium channel blockershypertension (p = 0.004) and absence of unstable angina (p = 0.046), beta blockers-hypertension (p = 0.01), and anti-lipid agents-hyperlipidemia (p = 0.0001) and number of diseased vessels (p = 0035). These data strongly indicate that patients referred for percutaneous coronary revascularization have inadequate pre-hospital medical treatment. PTCA (N = 500) DCA (N = 512) Aspirin 60.4% 58.6% Nitrates 53.8% 51.8% Ca Blockers 49.0% 45.7% Beta Blockers 32.2% 34.8% Anti-lipid Agents 11.0% 11.1%
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