Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22444
Title: Prognostic Significance of Suboptimal Secondary Prevention Pharmacotherapy After Acute Coronary Syndromes.
Authors: Yudi, Matias B;Farouque, Omar;Andrianopoulos, Nick;Ajani, Andrew E;Brennan, Angela;Murphy, Alexandra C;Lefkovits, Jeffrey;Reid, Christopher M;Oqueli, Ernesto;Sebastian, Martin;Duffy, Stephen J;Clark, David J
Affiliation: School of Public Health, Curtin University, Perth, Western Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Melbourne, Australia
Department of Cardiology, Ballarat Base Hospital, Ballarat, Australia
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
Department of Cardiology, Alfred Health, Melbourne, Australia
Department of Cardiology, Barwon Health, Geelong, Australia
Issue Date: 14-Jan-2020
EDate: 2020-01-14
Citation: Internal medicine journal 2020; online first: 14 January
Abstract: Optimal secondary prevention pharmacotherapy is the cornerstone of post-acute coronary syndrome (ACS) management. The prognostic impact of not receiving five guideline-recommended therapies is poorly described. We aim to ascertain the prognostic significance of suboptimal pharmacotherapy in ACS survivors. Consecutive patients with ACS from the Melbourne Interventional Group registry who were alive at 30-days following their index percutaneous coronary intervention were included. Patients were divided into three categories based on the number of secondary prevention medications prescribed. The optimal medical therapy (OMT), near-optimal medical therapy (NMT), suboptimal medical therapy (SMT) groups were prescribed 5, 4 and ≤3 medications, respectively. Primary endpoint was long-term mortality. Cox-proportional hazard modelling was undertaken to assess independent predictors of survival. Of the 9,375 patients included, 5,678 (60.6%) received OMT, 2,903 (31.0%) received NMT and 794 (8.5%) received SMT. Patients receiving SMT were older, more likely to be female and had higher burden of co-morbidities (renal impairment, congestive heart failure, diabetes, peripheral vascular disease; p<0.01 for all). SMT was associated with higher long-term mortality at 3.9±2.2 years when compared to NMT and OMT (16.8% vs. 10.5% vs. 8.2%, p<0.001). Compared to OMT, SMT was an independent predictor of long-term mortality (HR 1.62, 95% CI 1.30-2.02, p<0.01) while NMT was associated with a clinically significant 14% mortality hazard (HR 1.14, 95% CI 0.97-1.34, p=0.11). There is a graded long-term hazard associated with not receiving OMT after an ACS. Improvements in secondary prevention pharmacotherapy models of care are warranted to further decrease long-term mortality. This article is protected by copyright. All rights reserved.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22444
DOI: 10.1111/imj.14750
ORCID: 0000-0002-4248-7537
0000-0002-4518-5948
0000-0002-3706-4150
PubMed URL: 31943665
Type: Journal Article
Subjects: acute coronary syndromes
percutaneous coronary intervention
secondary prevention
survival
Appears in Collections:Journal articles

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