This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: August 18, 2009, Volume 120, Number 7 All Versions of this Article: 120/7/560    most recent CIRCULATIONAHA.109.877092v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Brilakis, E. S. Articles by Bhatt, D. L. PubMed PubMed Citation Articles by Brilakis, E. S. Articles by Bhatt, D. L. Related Collections Compliance/Adherence Risk Factors Acute coronary syndromes Epidemiology Related Article

(Circulation. 2009;120:560-567.)
© 2009 American Heart Association, Inc.

Coronary Heart Disease

Quality of Care for Acute Coronary Syndrome Patients With Known Atherosclerotic Disease

Results From the Get With the Guidelines Program

Emmanouil S. Brilakis, MD, PhD; Adrian F. Hernandez, MD, MHS; David Dai, MS; Eric D. Peterson, MD, MPH; Subhash Banerjee, MD; Gregg C. Fonarow, MD; Christopher P. Cannon, MD; Deepak L. Bhatt, MD, MPH

From the VA North Texas Healthcare System and University of Texas Southwestern Medical Center (E.S.B., S.B.), both in Dallas, Tex; Duke Clinical Research Institute and Duke University Medical Center (A.F.H, D.D., E.D.P.), Durham, NC; UCLA Medical Center (G.C.F.), Los Angeles, Calif; TIMI Group and Harvard University (C.P.C.), Boston Mass; and VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B), Boston, Mass.

Correspondence to Emmanouil S. Brilakis, MD, PhD, Dallas VA Medical Center (111A), 4500 S Lancaster Rd, Dallas, TX 75216. E-mail esbrilakis{at}yahoo.com

Received January 11, 2009; accepted June 8, 2009.

Background— Patients with prior atherosclerosis in 1 or more vascular territories (coronary, cerebrovascular, or peripheral arterial) who present with acute coronary syndromes have high cardiovascular risk and may benefit significantly from evidence-based therapies, yet whether these are used consistently is unknown.

Methods and Results— The Get With the Guidelines–Coronary Artery Disease database was queried to determine whether compliance with quality-of-care treatments for acute coronary syndrome patients was associated with the extent of prior vascular disease. A total of 143 999 patients enrolled at 438 sites between January 2000 and January 2008 were classified according to the absence (n=98 136; 68%) or presence of known preexistent atherosclerosis (before admission) in 1, 2, or 3 vascular territories (n=37 633 [26%], n=7369 [5%], and n=861 [0.6%], respectively). Overall in-hospital mortality was 5.3%, and mean length of stay was 5.6±6.7 days. Compared with patients without prior vascular disease, patients with prior vascular disease were older and had more comorbidities. They were less likely to undergo coronary revascularization and had longer duration of hospital stay and higher in-hospital mortality. After adjustment for clinical and hospital characteristics, compared with patients without prior vascular disease, patients with prior vascular disease had higher mortality and were less likely to receive 3 particular treatments (lipid-lowering therapy, smoking cessation counseling, and angiotensin-converting enzyme inhibitor for left ventricular dysfunction).

Conclusions— Compared with acute coronary syndrome patients without prior vascular disease, those with prior atherosclerosis had higher in-hospital mortality yet were paradoxically less likely to receive specific evidence-based acute coronary syndrome treatments, which can form the basis for targeted intervention.

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Clinical Summaries
Circulation 2009 120: 543-545. [Extract] [Full Text]