Abstract 5595: Secondary Prevention Performance Measures in Acute Coronary Syndrome Patients with Prior Monovascular or Polyvascular Atherosclerosis in the Get with the Guidelines Database
Introduction: Patients with prior atherosclerosis in one or more vascular territories (coronary, cerebrovascular, or peripheral arterial) who present with acute coronary syndromes have high cardiovascular risk and may significantly benefit from secondary prevention measures, yet the latter may be underutilized.
Methods: The Get With the Guidelines-Coronary Artery Disease database was queried to determine whether compliance with secondary prevention performance measures was different for acute coronary syndrome patients with vs. without prior vascular disease.
Results: 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 (prior to admission) in 1, 2, or 3 vascular territories (n=37,633; 26%, n=7,369; 5%, and n=861; 0.6%, respectively). Overall inhospital 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, more likely to have atrial fibrillation, diabetes, dyslipidemia, hypertension, smoking, low ejection fraction, or heart failure. They were also less likely to undergo cardiac catheterization and coronary revascularization and had longer duration of hospital stay and higher in-hospital mortality. After adjusting for clinical and hospital characteristics, compared with patients without prior vascular disease, prior vascular disease patients had higher mortality and were less likely to receive most secondary prevention measures (Table⇓).
Conclusions: Compared with acute coronary syndrome patients without prior vascular disease, those with prior atherosclerosis have higher in-hospital mortality and are less likely to receive most secondary prevention measures. Those patients may be an easily identifiable target for interventions to improve compliance with secondary prevention measures.
This research has received full or partial funding support from the American Heart Association, AHA National Center.