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

Application of Evidence-Based Medical Therapy Is Associated With Improved Outcomes After Percutaneous Coronary Intervention and Is a Valid Quality Indicator Wissam A. Jaber, Ryan J. Lennon, Verghese Mathew, David R. Holmes, Jr, Amir Lerman, Charanjit S. Rihal We aimed to determine whether the prescription of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering agents at discharge after percutaneous coronary intervention can predict long-term clinical outcome. We assigned a medication score (MEDS) of 1 to each of the medication classes prescribed to 7,745 patients who underwent a successful percutaneous coronary intervention. At a median follow up of 36 months, patients with a MEDS of 3 or 4 were at a significantly lower mortality or myocardial infarction in a multivariable analysis than those with a MEDS of 0 to 1 (hazard ratios of 0.72 and 0.67 for MEDS of 3 and 4, respectively; p < 0.01). 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. The association of standard-of-care drug utilization and long-term mortality and morbidity after PCI is not well studied. 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. 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. After successful PCI, the use of multiple evidence-based classes of cardiovascular medications—antiplatelet, lipid-l