Compliance with guideline-directed therapy in diabetic patients admitted with acute coronary syndrome: Findings from the American Heart Association's Get With The Guidelines–Coronary Artery Disease (GWTG-CAD) program

Deedwania, Prakash; Acharya, Tushar; Kotak, Kamal; Fonarow, Gregg C.; Cannon, Christopher P.; Laskey, Warren K.; Peacock, W. Frank; Pan, Wenqin; Bhatt, Deepak L.

doi:10.1016/j.ahj.2017.02.025

Cited by 16 publications

(7 citation statements)

References 43 publications

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“…8 However, the gap between clinical practice and guidelines has been previously described. 12 In the present study, we observed that the percentage of GDMT use at discharge was 69.4%, which was higher than previously reported. 9,10 This finding can be attributed to the nature of participating sites in our study that all came from large cardiac centers in United States, and to the patient population included in the current analysis who all present with an AMI.…”

Section: Discussioncontrasting

confidence: 74%

“…5 ACC/AHA guidelinedirected therapeutic regimens 6,7 are well known to improve long-term clinical prognosis in ACS patients undergoing PCI. Evidence-based medications such as beta-blockers, statins, ACEI/ARBs, aspirin and/or P2Y 12 inhibitors are individually effective in lowering recurrent adverse cardiovascular events in secondary prevention. Furthermore, the combination of these medications brings incremental benefits for ACS patients.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Although GDMT prescription at discharge has been reported to be around 63.2% in a Korean population, 11 a gap in compliance has also been demonstrated from the large nationwide AHA-Get With The Guidelines (GWTG) program. 12 The current study sought to determine the prevalence of GDMT use in acute myocardial infarction (AMI) patients undergoing PCI from the multicenter PROMETHEUS registry, and to investigate the predictors of GDMT prescription at discharge. Moreover, we examined the associations between GDMT use and 1-year clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The prevalence, predictors and outcomes of guideline‐directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry

Baber

Claessen

et al. 2018

Cathet Cardio Intervent

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Objectives To investigate the prevalence, predictors and associations between guideline‐directed medical therapy (GDMT) and clinical outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) from eight academic centers in the United States. Background Evidence for GDMT in patients with AMI comes from randomized controlled trials. The use of GDMT in clinical practice is unknown in this setting. Methods PROMETHEUS is a multicenter observational registry comprising 19,914 patients with acute coronary syndrome (ACS) undergoing PCI. Patients with AMI were divided into two groups based on the prescription of GDMT or not (non‐GDMT) at discharge. GDMT was defined according to American College of Cardiology/American Heart Association (ACC/AHA) class I recommendations, specifically, dual antiplatelet therapy, statin and beta‐blocker for all AMI patients, and additional ACEI/ARB in patients with left ventricular ejection fraction (LVEF) less than 40%, hypertension, diabetes mellitus (DM) or chronic kidney disease (CKD). The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of all‐cause death, MI, stroke or unplanned target vessel revascularization (TVR) at 1 year. Results Out of 4,834 patients with AMI, 3,356 (69.4%) patients were discharged on GDMT. Patients receiving GDMT were more often younger and male. Compared with non‐GDMT patients, GDMT patients had a significantly lower frequency of comorbidities. Predictors of greater GDMT prescription at discharge were ST‐segment elevation myocardial infarction (STEMI), and increased body mass index (BMI), whereas hypertension, prior PCI, anemia and CKD were associated with less GDMT prescription. At 1 year, the use of GDMT was associated with a significantly lower incidence of MACE (13.7% vs. 22.5%; adjusted HR 0.68; 95%CI 0.58–0.80; P < 0.001), death (3.7% vs. 9.4%; adjusted HR 0.61; 95%CI 0.46–0.80; P < 0.001), and unplanned TVR (8.4% vs. 11.3%; adjusted HR 0.76; 95%CI 0.61–0.96; P = 0.020). However, there were no significant differences in the incidence of MI (4.3% vs. 7.0%; adjusted HR 0.75; 95%CI 0.56–1.01; P = 0.056), stroke (1.5% vs. 2.0%; adjusted HR 0.79; 95%CI 0.47–1.34; P = 0.384) between the two groups. Conclusion In a contemporary practice setting in the United States, GDMT was utilized in just over two‐thirds of AMI patients undergoing PCI. Predictors of GDMT prescription at discharge included STEMI, BMI and absence of hypertension, CKD, anemia or prior PCI. Use of GDMT was associated with significantly lower risk of 1‐year MACE and mortality.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The prevalence, predictors and outcomes of guideline‐directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry

Baber

Claessen

et al. 2018

Cathet Cardio Intervent

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“…Так, например, в крупном наблюдательном исследовании P. Deedwania с соавт. было показано, что среди пациентов с ОКС любого возраста сравнительно более высокая частота смерти в стационаре отмечалась у больных с СД (6,4% против 5%; р<0,0001) [15]. Разницу полученных нами данных с данными литературы можно объяснить возрастающей с возрастом коморбидностью, которая в комплексе оказывает дополнительное влияние на показатели смерти в стационаре и после выписки из него.…”

Section: Discussionunclassified

“…В предыдущих исследованиях было показано, что пациенты любого возраста с ИБС и СД сравнительно чаще имеют многососудистое поражение коронарных артерий, у них выше риск развития ХБП, хронической и острой сердечной недостаточности и неблагоприятного исхода [14][15][16][17]. Установлено, что сердечно-сосудистые осложнения являются основной причиной смерти больных любого возраста с СД.…”

Section: Discussionunclassified

How Does the Presence of Diabetes Affect the Course of Acute Coronary Syndrome in Elderly Patients in Actual Clinical Practice?

Atabegashvili

Константинова

Muksinova

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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The number of elderly patients with diabetes mellitus (DM) is constantly growing in general population. Accordantly, we have the growth of such patients in the group of acute coronary syndrome (ACS).Aim.To compare clinical characteristics of the elderly patient (>75 years old) with and without DM.Material and methods. This retrospective study included 1133 ACS patients who were aged ≥75 years and admitted to the City Clinical Hospital №1 from 01.01.2015 to 31.12.2016. Median age was 80 years, 66% were women. We analyzed 4 patient subgroups: Group 1 – 105 patients with ST-segment elevation myocardial infarction (STEMI) and DM, Group 2 – 254 STEMI patients without DM, Group 3 – 222 non-STEMI patients with DM and Group 4 – 552 non-STEMI patients without DM. We used Student’s t-test and c2 tests to find significant difference between pairs of groups.Results. Median age of patients in 4 groups was 80, 81, 81 and 80 years (p>0.05), age variance was 75-100 years. DM was found in 29% of all elderly patients with no difference between STEMI and non-STEMI groups. STEMI and non-STEMI patients with DM were more likely women. NonSTEMI patients with DM more often had hypertension, previous stroke, lower median Hb (121 vs 127 g/l; p<0.001). Angiography data demonstrated more often three-vessel disease (43% vs 29.7%) and less one-vessel disease (15% vs 25.6%; p<0.05) between groups 3 and 4. Glomerular filtration rate (GFR) <60 ml/min/1.73 m2 occurred in 74%, 73%, 77% and 74% in patients of 4 groups (p>0,05), but GFR<45 ml/min/1.73 m2 was more prevalent in patients with DM than without DM: 45%, 39%, 45%, 36% in 4 groups. Finally, mortality rates didn’t demonstrate significant difference between DM and non-DM patients with STEMI (10% vs 13%; p>0.05) and non-STEMI (7% vs 7%) groups.Conclusion. DM is associated with ACS approximately in one third of the elderly patients and is not associated with its type (STEMI or non-STEMI). In STEMI and non-STEMI patients the female sex and GFR level <45 ml/min/1.73 m2 were associated with DM. In non-STEMI group multi-vessel disease and presence of hypertension and previous stroke were associated with DM. We didn’t find any difference between mortality in elderly patients with and without DM.

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Diabetes and Cardiovascular Disease

Coutiño-Castelán

Abundes-Velasco

Santos

et al. 2019

The Diabetes Textbook

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Compliance with guideline-directed therapy in diabetic patients admitted with acute coronary syndrome: Findings from the American Heart Association's Get With The Guidelines–Coronary Artery Disease (GWTG-CAD) program

Cited by 16 publications

References 43 publications

The prevalence, predictors and outcomes of guideline‐directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry

The prevalence, predictors and outcomes of guideline‐directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry

How Does the Presence of Diabetes Affect the Course of Acute Coronary Syndrome in Elderly Patients in Actual Clinical Practice?

Diabetes and Cardiovascular Disease

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