Patterns and Intensity of Medical Therapy in Patients Undergoing Percutaneous Coronary Intervention
- 11 May 2011
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA
- Vol. 305 (18), 1882-1889
- https://doi.org/10.1001/jama.2011.601
Abstract
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, β-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.This publication has 26 references indexed in Scilit:
- Recent Changes in Practice of Elective Percutaneous Coronary Intervention for Stable AnginaCirculation: Cardiovascular Quality and Outcomes, 2011
- Trends in Coronary Revascularization in the United States From 2001 to 2009Circulation: Cardiovascular Quality and Outcomes, 2011
- Heart Disease and Stroke Statistics—2011 UpdateCirculation, 2011
- Utilization of Secondary Prevention Therapies in Patients With Nonobstructive Coronary Artery Disease Identified During Cardiac CatheterizationCirculation: Cardiovascular Quality and Outcomes, 2010
- Impact of Changes in Clinical Practice Guidelines on Assessment of Quality of CareMedical Care, 2010
- The Immediate Impact of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial on the Management of Stable AnginaClinical Cardiology, 2009
- Heart Disease and Stroke Statistics—2009 UpdateCirculation, 2009
- Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in United States Adults Between 1988–1994 and 1999–2004Hypertension, 2008
- Comparisons of Guideline-Recommended Therapies in Patients With Documented Coronary Artery Disease Having Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Versus Medical Therapy Only (from the REACH International Registry)The American Journal of Cardiology, 2007
- Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failureThe American Journal of Cardiology, 2004