Prescription at discharge of recommended treatments for secondary prevention in patients with ST-segment elevation myocardial infarction according to reperfusion strategies. Results from the IN-ACS outcome study.
OBJECTIVE
To analyse discharge prescription of recommended treatments in patients with ST-segment elevation myocardial infarction (STEMI) according to reperfusion strategies.


METHODS
IN-ACS (Italian Network on Acute Coronary Syndromes) Outcome, an observational, multicenter study, enrolled 6045 ACS patients admitted within 48 h. In the present study we compared the discharge prescription rates of secondary prevention drugs among the 2144 patients with STEMI (72.5% men, age 65+/-13 years) who received primary percutaneous coronary intervention (pPCI) 1044 (48.7%) or thrombolytic therapy (TT) 575 (26.8%) or no reperfusion treatment (NR) 525 (24.5%).


RESULTS
Despite the higher risk profile, NR patients respect to pPCI and TT were less frequently receiving antiplatelet (93.0% versus 99.7% versus 96.4%), dual antiplatelet (57.9% versus 93.9% versus 62.8%), beta-blockers (71.2% versus 82.9 versus 75.0%) and statins (68.4% versus 78.6% versus 76.9%) (P <0.0001) at discharge. After multivariable analysis, NR respect to pPCI was an independent predictor of not receiving antiplatelet (OR: 19.6; 95% CI: 6.0-62.5), dual antiplatelet (OR: 10.2; 95% CI: 7.6-13.5), beta-blocker (OR: 1.6; 95% CI: 1.3-2.0).


CONCLUSIONS
According to our results NR patients with STEMI, despite their higher risk profile, were less likely to receive the recommended drugs at discharge compared to patients treated with pPCI.
Pedone
Chiara
C
Maggiore Hospital, Dept. of Cardiology, Bologna, Italy.
Di Pasquale
Giuseppe
G
Greco
Cesare
C
Gonzini
Lucio
L
Maggioni
Aldo P
AP
Pavesi
Pier Camillo
PC
Sabini
Alessandra
A
Boccanelli
Alessandro
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention / Q000458:organization & administration*; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome