Abstract 18340: Practice Patterns and Trends in the Use of Medical Therapy in Patients Undergoing Percutaneous Coronary Intervention

Abstract

Background: Clinical guidelines emphasize medical therapy as the initial approach to the management of patients with stable coronary artery disease (CAD). It is unknown to what degree medical therapy is applied before Percutaneous Coronary Intervention (PCI) in practice. We evaluated the practice patterns in the use of medical therapy in stable CAD patients undergoing PCI, and whether the COURAGE study changed medication practice patterns. Methods: We evaluated medication prescription rates in 23,680 patients over 65 years of age with stable CAD undergoing PCI in Ontario between December 2003 and March 2010. Medication use before and after PCI was compared, including after stratification on comorbidities and Canadian Cardiovascular Society (CCS) angina class, and in the periods before and after the publication of the COURAGE trial (March 2007). Optimal medical therapy (OMT) was defined as prescription for beta-blocker, statin and either ACE-inhibitor or ARB in the 90 days prior to PCI and the same medications along with a thienopyridine in the 90 days following PCI and suboptimal as having been prescribed at least one of the above medications. Results: Compared to before PCI, more patients were on optimal medical therapy after PCI [11,149 (47.1%) vs. 8023 (33.9%), p<0.001]. Patients who were receiving OMT were more likely to have comorbidities, cardiovascular disease and had a prior stress test. Patients with angina at higher CCS class were less likely to be on OMT prior to PCI as compared with post-PCI (29.5% vs. 51.1%, p<0.001). 11,984 (50.6%) patients underwent PCI in the period before publication of the COURAGE trial. Before PCI, OMT rate was lower in the period after the COURAGE trial compared with before the trial (32.8% vs. 34.9%, p<0.001). The rate of OMT following PCI was lower in the period after the COURAGE trial compared with before the trial (47.3% vs. 46.9%, p<0.001). Conclusion: Among patients with stable CAD undergoing PCI, only a third of patients were prescribed OMT in the 90 days prior to their procedure, and less than half were receiving optimal medical therapy in the 90 days following PCI. There was no substantial change in medical therapy practice pattern over the study period, including following the publication of the COURAGE trial.