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Prognostic significance of suboptimal secondary prevention pharmacotherapy after acute coronary syndromes.
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.
Afiliación
  • Yudi MB; Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
  • Farouque O; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
  • Andrianopoulos N; Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
  • Ajani AE; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
  • Brennan A; Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.
  • Murphy AC; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
  • Lefkovits J; Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.
  • Reid CM; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
  • Oqueli E; Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.
  • Sebastian M; Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
  • Duffy SJ; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
  • Clark DJ; Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.
Intern Med J ; 51(3): 366-374, 2021 Mar.
Article en En | MEDLINE | ID: mdl-31943665
BACKGROUND: 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. AIM: To ascertain the prognostic significance of suboptimal pharmacotherapy in ACS survivors. METHODS: 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. RESULTS: Of the 9375 patients included, 5678 (60.6%) received OMT, 2903 (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 comorbidities (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 (hazard ratio, HR 1.62, 95% confidence interval, 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). CONCLUSIONS: 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 the long-term mortality.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Síndrome Coronario Agudo / Intervención Coronaria Percutánea Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: Intern Med J Asunto de la revista: MEDICINA INTERNA Año: 2021 Tipo del documento: Article País de afiliación: Australia

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Síndrome Coronario Agudo / Intervención Coronaria Percutánea Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: Intern Med J Asunto de la revista: MEDICINA INTERNA Año: 2021 Tipo del documento: Article País de afiliación: Australia