Study Demonstrates Decreasing Medical Therapy Utilization Among Veteran Patients Treated with PCI Over 5 Years A cohort analysis of medication utility and the association between medication utility and MACE

11/6/2019- Joe X. Xie et. al recently published the results of a Veterans cohort study in Circulation. They were able to show a meaningful decline in the rate of important 4 post-PCI medication utilization (beta-blockers, statins, ACEI/ARB, and P2Y12 inhibitor) among Veterans in a follow-up period of 5 years, with the highest decrease in medication utility after the first year of PCI. They also showed continuous consumption of all these medications is associated with a decreased rate of major adverse cardiac events (MACE).

Medical therapy utilization and association between medical therapy and MACE were the study’s primary outcomes. They included 57,900 patients who underwent staged PCI, defined as PCI on a non-STEMI lesion and if the PCI is being performed on a segment that had not been treated before. They excluded patients who were in the setting of cardiogenic shock, those who did not survive the index hospitalization following PCI, patients who obtain all their medications outside the VA, or those with a documented allergy to any of the four medication classes of interest. The majority were white elderly males, they usually used tobacco (62%), and most of them had comorbidities including hypertension (89.4%), diabetes mellitus (47.1%), and hyperlipidemia (88.4%) as main comorbidity factors. The mean duration of follow-up was 5 years. During an average follow-up of 5 years, a total of 24,364 patients experienced MACE which was defined as the first occurrence of all-cause death, rehospitalization for MI, rehospitalization for stroke, or repeat revascularization throughout the follow-up. They found a statistically significant correlation between death reduction and stroke rehospitalization and medication utility up to 5 years after PCI but not rehospitalization for MI. In their analysis, Xie and his colleagues calculated that less than 60% of the patients undergoing PCI receive all 4 medication classes at discharge (β-blocker, statin, ACE inhibitor/ARB, and P2Y12 inhibitor), with a gradual decrease of medication utility for approximately 20% of statins, β-blockers, and ACE inhibitor/ARBs over the subsequent 5 years post-PCI. This rate was reported to decrease to approximately 70% for the use of P2Y12 inhibitors.

Previously, there was little evidence available concerning the rate of long-term use of medical therapy following PCI. It has been shown that there is a suboptimal medication adherence by patients 6-12 months after PCI. Xie et al. also showed that all the described medication therapy classes were associated with decrease in the MACE risk even at 5 years post-PCI. They also noticed that all 4 classes of medications were associated with decreased MACE rates.

The data shown by Xie et al. can help with understanding patient compliance to medications, and to implement methods to increase the compliance. Further studies for non-VA patients are recommended.