Predictors of long-term use of evidence-based therapies after non-ST-segment elevation acute coronary syndrome. The S-Témoin survey

Abstract

Background We evaluated correlates of prolonged use of evidence-based therapies in patients discharged after non-ST-segment elevation acute coronary syndrome (NSTE ACS). Methods 598 cardiologists enrolled 2443 patients at outpatient clinics 2–12 months after discharge for NSTE ACS. The use of cardiac medications for secondary prevention (antiplatelets, beta-blockers, angiotensin-converting enzymes, and statins) was evaluated. Results A total of 2386 (97.7%) patients were on either antiplatelet monotherapy ( n = 623, 26.1%) or combination therapy ( n = 1763, 73.9%) at follow-up. Combination antiplatelet therapy declined by 23 percentage points (82.3% to 59.4%) 9–12 months after discharge, whereas use of other cardiac medications remained constant or increased. After multivariable analysis, the strongest predictors of combination antiplatelet therapy were PCI with a stent (odds ratio [OR] 3.75, 95% confidence interval [CI] 2.12–6.67), drug-eluting stents (OR 3.25, 95% CI 1.73–6.08), late PCI (OR 3.21, 95% CI 2.12–4.87) and statins at discharge (OR 1.98, 95% CI 1.40–2.80). Among the independent predictors of beta-blocker and statin use were extent of coronary artery disease and cardiac medications prescribed at discharge. Conclusions After NSTE ACS, implementation of recommendations on long-term use of evidence-based therapies depends largely on in-hospital management. A variety of clinical characteristics are also predictive of long-term use.