Impact of availability and use of coronary interventions on the prescription of aspirin and lipid lowering treatment after acute coronary syndromes

Abstract

Background: It has been suggested that patients undergoing acute intervention for coronary syndromes may not receive adequate secondary prevention.

Objective: To analyse the impact of availability and use of coronary interventions on the prescription of secondary prevention after acute coronary syndromes.

Design: Analysis of a prospective multicentre register of patients admitted to hospital for acute coronary syndromes.

Setting: A 1999 pan-European survey in 390 hospitals.

Patients: 3092 patients admitted to hospital with acute coronary syndromes (including 777 for ST elevation myocardial infarction within 12 hours of onset).

Main outcome measures: Rates of prescription of aspirin and lipid lowering agents.

Results: Performance of coronary angiography and percutaneous coronary interventions (PCI) during the hospital stay were independent predictors of prescription of aspirin at discharge (odds ratio (OR) 1.29 and 1.89, p = 0.053 and p < 0.0001, respectively). Lipid lowering agents were prescribed more often on discharge in patients admitted to hospitals with catheterisation laboratories than without (for infarction with ST elevation, 45% v 40% (NS); for other acute coronary syndromes, 46% v 36%; p < 0.05). Prescription rates were higher among patients undergoing coronary angiography or PCI than in those treated conservatively (for infarction with ST elevation, 49%, 53%, and 39%, p < 0.05; for other acute coronary syndromes, 50%, 54%, and 34%, p < 0.05). Logistic regression analysis showed that PCI was an independent predictor of prescription of lipid lowering agents at discharge (OR 1.48, p < 0.0002).

Conclusions: Contrary to expectations, invasive procedures for acute coronary syndromes are associated with higher rates of prescription of pharmacological secondary prevention.

Figures

Figure 1

Prescription of lipid lowering treatment at discharge as a function of hospital type. Cath lab+/−, hospitals with or without a catheterisation laboratory; STE-MI, ST elevation myocardial infarction; ACS, acute coronary syndromes. *p

Figure 2

Prescription of lipid lowering treatment at discharge as a function of invasive procedures performed during the index hospital stay. p