Key result
Prescription of the full combination of five evidence-based medications post-revascularization for ACS significantly reduced MACCE rates compared to partial prescription (ATE -25%; 95% CI -40 to -10; P=0.001).
Why the study?
Guidelines recommend five evidence-based medications (EBM) post-revascularization for ACS, but the prevalence and clinical impact of prescribing the full combination versus a partial combination remained to be evaluated.
Does the full combination of five evidence-based medications reduce major adverse cardiovascular and cerebrovascular events in patients with acute coronary syndrome post-revascularization?
Cohort
Does the full combination of five evidence-based medications reduce major adverse cardiovascular and cerebrovascular events in patients with acute coronary syndrome post-revascularization?
Effect estimate: ATE -25% (95% CI -40 to -10)
Absolute Event Rate: 37% vs 54%
p-value: p=0.001
Prescribing the full combination of five evidence-based medications post-revascularization for ACS is associated with a significant reduction in MACCE compared to partial prescription.
May support full therapy post-ACS revascularization; leaves open causal confirmation in randomized trials.
Objectives: International cardiovascular guidelines recommend prescribing a combination of five evidence-based medications (EBM) for acute coronary syndrome (ACS) patients post-revascularization. This study aims to assess the prevalence and impact of prescribing the full (five medications) versus partial (four medications or fewer) EBM combination on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ACS post-revascularization. Methods: Data from patients with ACS who had revascularization between January 2016 and September 2021 were collected retrospectively. Patients were then followed up until March 2022 for MACCE. Results: The full EBM combination was prescribed to 70% of the patients. However, after taking into account the presence of contraindications and clinical factors, the actual adherence to the guidelines was 95%. Patients who received the full EBM combination were younger (58 versus 62 years; p = 0.0 and 3) and had lower rates of chronic kidney disease (11% versus 41%; p < 0.001) and heart failure (9% versus 20%; p = 0.012) when compared to patients who received the partial EBM. Compared to the partial EBM group, the full EBM group was associated with lower MACCE rates (54% versus 37%, p = 0.012). After employing the propensity score technique utilizing the 1:1 nearest neighbor matching method without replacement, the univariate findings were further re-affirmed with those on full EBMs (compared to those on partial EBMs) associated with a significant reduction in the MACCE rate (average treatment effect of −25%; 95% confidence interval: −10–−40%; p = 0.001). Conclusions: The full EBM utilization was significantly high in our setting and in line with international guidelines. The full EBM combination was predominantly prescribed in younger and less comorbid patients and was associated with lower MACCE rates. The findings were further reaffirmed by the propensity score matching method.
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Al-Hadithy et al. (2023) conducted a cohort in Acute coronary syndrome (ACS) post-revascularization. Full evidence-based medications (five medications) vs. Partial evidence-based medications (four medications or fewer) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) (ATE -25%, 95% CI -40 to -10, p=0.001). Prescription of the full combination of five evidence-based medications post-revascularization for ACS significantly reduced MACCE rates compared to partial prescription (ATE -25%; 95% CI -40 to -10; P=0.001).
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