title: The impact of age and chronic kidney disease on secondary prevention post-primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Historical data suggest elderly patients and those with chronic kidney disease (CKD) receive suboptimal secondary prevention following myocardial infarction (MI). We evaluated the impact of age and CKD on secondary prevention following primary percutaneous coronary intervention (PPCI) in a contemporary unselected cohort.
  
  
  METHODS
  We studied 1169 consecutive patients from five UK centres receiving PPCI for ST elevation MI, with use of evidence-based secondary prevention at discharge assessed by age (<60, 60-75 and >75 years) and estimated glomerular filtration rate (eGFR). Follow-up prescribing practice was assessed in 567 patients.
  
  
  RESULTS
  One-fifth of patients receiving PPCI were >75 years. This group received fewer secondary prevention drugs at discharge compared to younger patients (P < 0.01 for β-blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and statins). By 6 weeks post-PPCI, there was a small drop-off in evidence-based therapy; β-blocker and statin use in those >75 years fell from 90% to 86% and 96% to 93%, respectively. CKD (eGFR<60 ml/min/1.73 m(2)) was seen in 17.6%. Declining renal function was associated with age, female sex and lower use of ACE inhibitor/ARB. At discharge 83.5% of patients with eGFR<60 ml/min/1.73 m(2) were receiving ACE inhibitors/ARB, dropping to 77.5% at 6 weeks (compared with 95% and 92%, respectively, in patients with eGFR >60 ml/min/1.73 m(2)).
  
  
  CONCLUSIONS
  The uptake of secondary prevention medication is high following PPCI in the UK, even in the elderly and in those with renal dysfunction. A focus on strategies to improve up-titration and continuation of drugs following discharge is required.
authors.affiliation: Cardiology Department, Queen Alexandra hospital, Southwick Hill Rd, Cosham, Portsmouth, PO6 3LY, UK. donahez@hotmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Zachariah
authors.forename: R
authors.initials: R
authors.lastname: Brown
authors.forename: P
authors.initials: P
authors.lastname: Kanagala
authors.forename: A
authors.initials: A
authors.lastname: Bashir
authors.forename: M
authors.initials: M
authors.lastname: Mohan
authors.forename: P
authors.initials: P
authors.lastname: Callan
authors.forename: R
authors.initials: R
authors.lastname: Rajendra
authors.forename: A L
authors.initials: AL
authors.lastname: Clark
authors.forename: I
authors.initials: I
authors.lastname: Squire
authors.forename: M
authors.initials: M
authors.lastname: Gunning
authors.forename: C C
authors.initials: CC
authors.lastname: Lang
authors.forename: P R
authors.initials: PR
authors.lastname: Kalra
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors