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CLINICAL RESEARCH

Application of Evidence-Based Medical Therapy Is Associated With Improved Outcomes After Percutaneous Coronary Intervention and Is a Valid Quality Indicator

Mayo Clinic, Rochester, Minnesota

Manuscript received March 16, 2005; revised manuscript received June 23, 2005, accepted June 27, 2005.

^_* Reprint requests and correspondence: Dr. Charanjit S. Rihal, Director, Cardiac Catheterization Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: rihal{at}mayo.edu).

OBJECTIVES: We sought to determine whether the prescription of evidence-based medications at discharge after successful percutaneous coronary intervention (PCI) can predict long-term clinical outcome.

BACKGROUND: The association of standard-of-care drug utilization and long-term mortality and morbidity after PCI is not well studied.

METHODS: We performed a retrospective cohort study of successful PCI procedures performed on 7,745 patients between March 1, 1998, and December 31, 2004. Discharge medications were analyzed, and a medication score (MEDS) was developed. A MEDS of 1 was assigned for each of the following medication classes: 1) antiplatelet, 2) lipid-lowering, 3) beta-blocker, and 4) angiotensin-converting enzyme (ACE) inhibitor. The outcomes measured were long-term death, myocardial infarction, and revascularization.

RESULTS: Patients with MEDS of 3 to 4 had higher-risk profiles based upon standard clinical and angiographic criteria. Despite this, at a median follow-up of 36 months, patients with a MEDS of 3 or 4 were at lower risk of death than those with a MEDS of 0 or 1 (8.9%, 7.5%, and 13% for MEDS of 4, 3, and 0 to 1, respectively; p = 0.014). After adjustment for covariates, a MEDS of 3 to 4 was associated with significantly lower mortality or myocardial infarction in follow-up than a MEDS of 0 to 1 (hazard ratios of 0.72 and 0.67 for MEDS of 3 and 4, respectively; p < 0.01). There was no association between MEDS and target vessel revascularization.

CONCLUSIONS: After successful PCI, the use of multiple evidence-based classes of cardiovascular medications—antiplatelet, lipid-lowering, beta-blockers, and ACE inhibitors—is associated with improved outcome free of death or MI.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CABG = coronary artery bypass graft surgery   CHF = congestive heart failure   CI = confidence interval   HR = hazard ratio   MEDS = medication score   MI = myocardial infarction   PCI = percutaneous coronary intervention   TVR = target vessel revascularization

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