Patients undergoing PCI were significantly more likely to be prescribed statins (96% vs 73%, p<0.001) and ACE inhibitors (65% vs 26%, p<0.001) at discharge compared to those undergoing CABG.
Cohort (n=200)
No
Does the type of coronary revascularisation (PCI vs CABG) affect the likelihood of being prescribed secondary prevention therapies at discharge?
Secondary prevention prescribing at discharge is suboptimal after coronary revascularization, with significant underprescribing of statins and ACE inhibitors following CABG compared to PCI.
Absolute Event Rate: 96% vs 73%
p-value: p=<0.001
BACKGROUND: This study tested the hypothesis that the opportunity to start secondary prevention therapy before discharge after coronary revascularisation is being missed. The study assessed current prescribing practice and identified discrepancies in prescribing for patients managed by surgeons (especially) and cardiologists. METHODS: 200 consecutive patients from the Manchester Heart Centre percutaneous coronary intervention (PCI) and coronary artery bypass (CABG) registries were identified (100 from each registry) and the notes analysed. All had undergone coronary revascularisation from February 2002 to March 2002. Data were analysed using SPSS for Windows, version 10.1. RESULTS: After exclusion of two patients with contraindications, 100% (98 of 98) of PCI patients and 92% (90 of 98) CABG patients were prescribed aspirin at discharge. Eight two per cent of eligible PCI patients and 70% of eligible CABG patients were prescribed beta blockers at discharge. Ninety six per cent (96 of 100) of PCI patients and 73% (73 of 100) of CABG patients were prescribed statins of any dose at discharge, (p<0.001). Sixty five per cent of PCI but only 26% of CABG patients were discharged prescribed ACE inhibitors (eligible patients based on HOPE, heart outcomes prevention evaluation trial), (p<0.001). CONCLUSIONS: Secondary prevention prescription after coronary revascularisation remains suboptimal in all but aspirin use. Patients in the PCI group were statistically more likely to be discharged prescribed a statin or an ACE inhibitor, or both, than patients after CABG. Both interventional cardiologists and (especially) cardiac surgeons must improve their use of secondary prevention therapy.
Fox et al. (Wed,) conducted a cohort in Coronary revascularisation (n=200). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass (CABG) was evaluated on Prescription of statins at discharge (p=<0.001). Patients undergoing PCI were significantly more likely to be prescribed statins (96% vs 73%, p<0.001) and ACE inhibitors (65% vs 26%, p<0.001) at discharge compared to those undergoing CABG.