Abstract

Objective: Historical data suggest elderly patients and those with chronic kidney disease (CKD) receive suboptimal secondary prevention following myocardial infarction (MI). We evaluated the impact of age and CKD on secondary prevention following primary percutaneous coronary intervention (PPCI) in a contemporary unselected cohort.

Design: We studied 1169 consecutive patients from five UK centres receiving PPCI for ST elevation MI, with use of evidence-based secondary prevention at discharge assessed by age (<60, 60–75 and >75 years) and estimated glomerular filtration rate (eGFR). Follow-up prescribing practice was assessed in 567 patients.

Results: One-fifth of patients receiving PPCI were >75 years. This group received fewer secondary prevention drugs at discharge compared to younger patients (P < 0.01 for β-blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and statins). By 6 weeks post-PPCI, there was a small drop-off in evidence-based therapy; β-blocker and statin use in those >75 years fell from 90% to 86% and 96% to 93%, respectively. CKD (eGFR<60 ml/min/1.73 m2) was seen in 17.6%. Declining renal function was associated with age, female sex and lower use of ACE inhibitor/ARB. At discharge 83.5% of patients with eGFR<60 ml/min/1.73 m2 were receiving ACE inhibitors/ARB, dropping to 77.5% at 6 weeks (compared with 95% and 92%, respectively, in patients with eGFR >60 ml/min/1.73 m2).

Conclusions: The uptake of secondary prevention medication is high following PPCI in the UK, even in the elderly and in those with renal dysfunction. A focus on strategies to improve up-titration and continuation of drugs following discharge is required.

Introduction

Despite major advances in secondary prevention following myocardial infarction (MI) historical data suggest that older patients and those with co-morbidities such as chronic kidney disease (CKD) are less likely to be prescribed prognostically beneficial drugs. Such patients have a high absolute risk of an adverse outcome and thus have greater overall potential for benefit from therapy.1,2 Yet studies in post-MI patients in the nineties have shown the utilization of secondary prevention to be as low as 8.6% (for the combination of aspirin, beta blockers and angiotensin-converting enzyme (ACE) inhibitors) in the presence of severe CKD.3 The Valsartan in Acute Myocardial Infarction Trial (VALIANT)4 with 14 527 acute MI patients complicated by heart failure, highlighted this under-utilization of aspirin, β-blockers and statins and additionally showed that declining eGFR was associated with increased risk of death and non-fatal cardiovascular outcomes.

The benefits of secondary prevention post-MI are similar in both older and younger patients,5 yet patients with the highest absolute risk (the elderly) receive lower quality of care.6,7 Shilpak et al.8 evaluated 20 902 patients >65 years of age admitted with acute MI and left ventricular ejection fraction (LVEF) <40%. At discharge, 44% were receiving ACE inhibitors, 13% β-blockers, 16% both and 28% neither medication. Those patients who were treated with ACE inhibitors or β-blockers had better 1-year outcomes than those who were not treated with greater benefit seen in those with serum creatinine 176 µmol/l or greater, or where used in combination.

There are a number of plausible reasons as to why high risk patients with CKD or advancing age receive sub-optimal therapy post-MI. These include the apprehension that drugs such as ACE inhibitors may result in detrimental effects on renal function (e.g. in the presence of renal artery stenosis, which would be anticipated to be common in elderly patients presenting with ischaemic heart disease)or are poorly tolerated, the failure of healthcare systems to provide specialist cardiology care to older patients or those with co-morbidity, or even a belief that these patients are beyond help (‘therapeutic nihilism’).9 Treating acute MI with primary percutaneous coronary intervention (PPCI), irrespective of age or renal function (the latter is usually unknown when taken to the catheterization laboratory), may have reduced the possible bias in healthcare professionals against prescribing in high-risk groups.

We hypothesized that PPCI would be associated a high uptake of secondary prevention medication and aimed to assess the influence of age and renal function on secondary prevention medication in five UK sites offering PPCI.

Methods

This was a retrospective cohort review of five UK cardiac centres (Dundee, Hull, Leicester, Portsmouth, Stoke-on-Trent) providing primary PCI for acute STEMI. A cohort of consecutive patients undergoing PPCI (2010–11) who survived to discharge was included at each centre. Demographic data (age and sex) and results of local laboratory investigations at presentation (including haemoglobin, serum creatinine and estimated glomerular filtration rate) were recorded. Secondary prevention medications (statins, ACE inhibitors or angiotensin receptor blockers (ARB), β-blockers as well as anti-platelet treatment) prescribed at discharge were obtained from electronic discharge summaries or case note evaluation.

We also considered prescribing practice following discharge, in particular to assess the extent of drug withdrawal and titration in relation to age and renal dysfunction. Many of the included patients were followed up by their local non-PPCI centre. Only patients who attended a post-MI clinic at their PPCI centre were included in further analysis.

We compared medication prescription according to patient age and renal function. We categorized the population into three groups according to age: <60 years, 60–75 years and >75 years. Renal function was quantified as eGFR in ml/min/1.73 m2 according to local laboratory calculations from the four-component MDRD equation incorporating age, race, sex and serum creatinine level10: estimated GFR = 186 × (serum creatinine level [in milligrams per decilitre])–1.154 × (age [in years])–0.203. The population was divided into three groups based upon the Kidney Disease Outcomes Quality Initiative guidelines10: eGFR ≥ 60 ml/min/1.73 m2 (CKD class 1 and 2), eGFR 45-59 ml/min/1.73 m2 (CKD class 3a) and eGFR <45 ml/min/1.73 m2 (CKD class 3b, 4 and 5).We anticipated that the unselected patient population would include many elderly individuals and therefore felt that it was important to separate CKD class 3 into 3a and 3b particularly since previous studies showed patients with eGFR <45 ml/min/1.73 m2 receive the poorest secondary prevention.4

We also examined the doses of medication prescribed. As there are a number of different drugs in each class, we used dose equivalence within each group. Bisoprolol was the most commonly prescribed β-blocker and other β-blocker dosages were expressed as ‘bisoprolol equivalent doses’ based on the proportion of maximal doses recommended in clinical guidelines11 (2.5 mg bisoprolol OD = 6.25 mg carvedilol BD = 25 mg atenolol OD = 25 mg metoprolol BD = 2.5 mg timolol BD). Similarly ramipril was the most commonly used ACE inhibitor and other ACE inhibitor doses were expressed as ‘ramipril equivalent doses’ based on the proportion of maximal doses recommended in the ESC ST elevation MI management guidelines11 (2.5 mg ramipril = 2 mg perindopril = 5 mg lisinopril). As the number of patients prescribedARBs was very low (4.3%), we did not calculate equivalent ARB doses, but did include patients prescribed an ARB as being on an inhibitor of the rennin-angiotensin system.

Local audit committee and/ or Caldicott guardian approval was obtained for each participating site. The anonymous amalgamated data were analysed.

Statistical analysis

Statistical analyses were performed using SPSS software version 19. Comparisons between different groups were performed by one-way analysis of variance (ANOVA). Cumulative values are presented as percentages and results for normally distributed data are presented as mean ± standard deviation (SD). All values are two-tailed and P < 0.05 was considered statistically significant.

Results

Complete drug history and demographics were available for 1169 of the 1218 potential patients and these formed the final dataset. Two patients for whom no creatinine values were available were excluded from the analysis dependent on eGFR. The mean age of the study population was 63.7 ± 12.6 years, 73.3% were male and 20% aged >75 years.

Discharge prescribing data

At discharge, 91.7% of the study population were prescribed an ACE inhibitor (90.4% of females and 92.3% of males), 93.6 % a β-blocker (92% of females and 94% of males) and 98.2% a statin (97.4% of females and 99% of males). There was no statistical difference in secondary prevention prescription between sexes.

Renal function (Table 1)

Estimated GFR <60 ml/min/1.73 m2 was seen in 17.6%. The proportion of women increased with worsening renal function.

The proportion of patients prescribed β-blockers or statins was similar among the three eGFR groups (Table 1). In contrast, the prescription of ACE inhibitors /ARB was lower in the group with the worst renal function: 76% compared to >90% in patients with eGFR ≥ 45 ml/min/1.73 m2.

Table 1

Data classified according to eGFR (ml/min/1.73 m2) showing demographics as well as utilization of secondary prevention medication at discharge from hospital post-primary angioplasty (total n = 1167)

Discharge eGFR≥60 eGFR 45-59 eGFR <45 P-value 
N (%) 962 (82) 138 (12) 67 (6)  
Mean eGFR (SD) 84 (17) 54 (4) 33 (10)  
Male (%) 738 (77) 84 (61) 34 (51) 0.025 
Age in years (SD) 62 (12) 73 (10) 75 (12) 0.108 
% on β-blocker BB 94 88 91 0.871 
% on ACE/ARB 95 91 76 <0.001 
% on statin 98 96 96 0.914 
Bisoprolol 3.4 (1.97) 2.9 (1.44) 3.6 (2.86) 0.3 
Ramipril 3.8 (2.4) 4.0 (2.9) 4.0 (2.6) <0.001 
Discharge eGFR≥60 eGFR 45-59 eGFR <45 P-value 
N (%) 962 (82) 138 (12) 67 (6)  
Mean eGFR (SD) 84 (17) 54 (4) 33 (10)  
Male (%) 738 (77) 84 (61) 34 (51) 0.025 
Age in years (SD) 62 (12) 73 (10) 75 (12) 0.108 
% on β-blocker BB 94 88 91 0.871 
% on ACE/ARB 95 91 76 <0.001 
% on statin 98 96 96 0.914 
Bisoprolol 3.4 (1.97) 2.9 (1.44) 3.6 (2.86) 0.3 
Ramipril 3.8 (2.4) 4.0 (2.9) 4.0 (2.6) <0.001 

Drug doses expressed as mean equivalent dose milligrams (SD).

Age (Table 2)

Increasing age was associated with lower eGFR (P < 0.001). Fewer patients aged >75 years received β-blockers, ACE inhibitors/ARBs and statins at discharge compared with the other groups (P = 0.009 for β-blockers and <0.001 for other drug categories). The mean bisoprolol dose equivalent was lowest for those aged >75 years.

Table 2

Data classified according to age showing demographics and utilization of secondary prevention medication at discharge from hospital post-primary angioplasty (n = 1169)

Discharge <60 years 60–75 years >75 years P-value 
N (%) 454 (39) 481 (41) 234 (20)  
Male (%) 367 (81) 353 (73) 137 (59) <0.001 
Mean Creatinine (SD), µmol/l 82 (38) 86 (26) 108.7 (85) <0.001 
Mean eGFR 87 (22) 74 (19) 59 (19) <0.001 
% on β-blocker 95 94 90 0.009 
% on ACE/ARB 96 94 87 <0.001 
% on statin 99 99 96 <0.001 
Bisoprolol 3.3 (1.85) 3.5 (2.08) 2.9 (2.01) <0.001 
Ramipril 3.7 (2.31) 4.1 (2.53) 3.7 (2.58) 0.145 
Discharge <60 years 60–75 years >75 years P-value 
N (%) 454 (39) 481 (41) 234 (20)  
Male (%) 367 (81) 353 (73) 137 (59) <0.001 
Mean Creatinine (SD), µmol/l 82 (38) 86 (26) 108.7 (85) <0.001 
Mean eGFR 87 (22) 74 (19) 59 (19) <0.001 
% on β-blocker 95 94 90 0.009 
% on ACE/ARB 96 94 87 <0.001 
% on statin 99 99 96 <0.001 
Bisoprolol 3.3 (1.85) 3.5 (2.08) 2.9 (2.01) <0.001 
Ramipril 3.7 (2.31) 4.1 (2.53) 3.7 (2.58) 0.145 

Drug doses expressed as mean equivalent dose mg (SD), eGFR in ml/min/1.73 m2.

The proportion of patients prescribed ARB rather than ACE inhibitor increased as eGFR dropped and as age increased (Table 3).

Table 3

Utilization of ARBs among different age and eGFR categories (eGFR in ml/min/1.73 m2)

 Discharge
 
Follow-up 
 Number on ARB of total on ACE(i) + ARB Percentage % Number on ARB of total on ACE(i) + ARB 
<60 years 11 of 436 2.5 10 of 204 
60–75 years 19 of 452 4.2 18 of 222 
>75 years 20 of 204 9.8 8 of 93 
eGFR <45 8 of 51 15.7 3 of 19 
eGFR 45–59 6 of 126 4.8 6 of 66 
eGFR ≥60 39 of 914 4.3 28 of 427 
 Discharge
 
Follow-up 
 Number on ARB of total on ACE(i) + ARB Percentage % Number on ARB of total on ACE(i) + ARB 
<60 years 11 of 436 2.5 10 of 204 
60–75 years 19 of 452 4.2 18 of 222 
>75 years 20 of 204 9.8 8 of 93 
eGFR <45 8 of 51 15.7 3 of 19 
eGFR 45–59 6 of 126 4.8 6 of 66 
eGFR ≥60 39 of 914 4.3 28 of 427 

Follow-up

Follow-up data were available on 567 (49%) patients from three centres (Tables 4 and 5). Most patients were followed up at 6 weeks post-MI as per protocol of the hospital. Mean age was 62.3 ± 13.2 years and 18.2% of the follow-up cohort had an eGFR <60 ml/min/1.73 m2. A total of 73.6% were male and 20% of the follow-up population was aged >75 years. There was no statistical difference in proportions between the follow-up cohort and the overall population. There was a similar pattern of prescribing at follow-up with the patients with a lower eGFR less likely to be prescribed ACE inhibitors. At 6 weeks post-angioplasty, the mean bisoprolol dose was lower and use of ACE inhibitors was lower in patients >75 years old. There was a small decline in prescribing of all classes of secondary preventative drugs at 6 weeks, although this did not reach statistical significance (Tables A1 and A2). There was no significant difference in mean doses of ACE inhibitors or β-blockers at follow-up compared to discharge.

Table 4

Data classified according to eGFR (ml/min/1.73 m2) showing demographics as well as utilization of secondary prevention medication at 6 weeks post-primary angioplasty for STEMI (total n = 567)

Follow-up EGFR≥60 EGFR 45-59 EGFR <45 P-value 
N (%) 464 (82) 74 (13) 29 (5)  
Mean eGFR (SD) 82 (15) 54 (4) 35 (8)  
Male (%) 363 (78) 43 (58) 13 (45) <0.001 
% on β-blocker 90 86 86 0.899 
% on ACE/ARB 92 89 66 0.015 
% on statin 96 96 90 0.446 
Bisoprolol 3.4 (1.99) 3.1 (1.80) 3.8 (3.13) 0.002 
Ramipril 3.7 (2.32) 3.6 (2.14) 3.2 (2.08) 0.569 
Follow-up EGFR≥60 EGFR 45-59 EGFR <45 P-value 
N (%) 464 (82) 74 (13) 29 (5)  
Mean eGFR (SD) 82 (15) 54 (4) 35 (8)  
Male (%) 363 (78) 43 (58) 13 (45) <0.001 
% on β-blocker 90 86 86 0.899 
% on ACE/ARB 92 89 66 0.015 
% on statin 96 96 90 0.446 
Bisoprolol 3.4 (1.99) 3.1 (1.80) 3.8 (3.13) 0.002 
Ramipril 3.7 (2.32) 3.6 (2.14) 3.2 (2.08) 0.569 

Drug doses expressed as mean equivalent dose mg (SD).

Table 5

Data classified according to age showing demographics and utilization of secondary prevention medication at 6 weeks post-primary angioplasty (total n = 567)

Follow-up  <60 years 60–75 years >75 years P-value 
N (%)  212 (37) 243 (43) 112 (20)  
Male (%)  179 (84) 176 (72) 66 (59) <0.001 
Mean creatinine (SD) µmol/l 79 (18) 86 (26) 100 (34) 0.028 
Mean eGFR (SD)  85 (18) 73 (26) 61 (18) <0.001 
% on β-blockers  91 90 86 0.063 
% on ACE/ARB  96 91 83 0.006 
% on statin  97 96 93 0.176 
Bisoprolol  3.3 (1.80) 3.6 (2.55) 3.2 (2.36) 0.02 
Ramipril  3.3 (2.30) 3.8 (2.38) 3.4 (2.01) 0.058 
Follow-up  <60 years 60–75 years >75 years P-value 
N (%)  212 (37) 243 (43) 112 (20)  
Male (%)  179 (84) 176 (72) 66 (59) <0.001 
Mean creatinine (SD) µmol/l 79 (18) 86 (26) 100 (34) 0.028 
Mean eGFR (SD)  85 (18) 73 (26) 61 (18) <0.001 
% on β-blockers  91 90 86 0.063 
% on ACE/ARB  96 91 83 0.006 
% on statin  97 96 93 0.176 
Bisoprolol  3.3 (1.80) 3.6 (2.55) 3.2 (2.36) 0.02 
Ramipril  3.3 (2.30) 3.8 (2.38) 3.4 (2.01) 0.058 

Drug doses expressed as mean equivalent dose mg (SD), eGFR in ml/min/1.73 m2.

We additionally evaluated the impact of change in eGFR during the course of admission on ACEinhibitor/ ARB utilization in three centres. Day 3 eGFR (when the potential effects of contrast nephropathy are likely to peak) was performed in 413 of 787 patients (52.4%). We divided this population (n = 413) into those with or without a clinically meaningful drop in eGFR (≥5 ml/min/1.73 m2) during admission. A ≥5 ml/min/1.73 m2 drop in eGFR on Day 3 was seen in 34% (n = 140) and was associated with lower utilization of ACE inhibitor/ARB (62 vs. 73%, P= 0.0001) and a trend towards lower dose of ramipril equivalent (2.5 mg vs. 3.0 mg, P= 0.058).

Discussion

Our study shows that in the contemporary era of PPCI for acute STEMI, adherence to guidelines regarding secondary prevention pharmacological therapy is very high. In patients treated with PPCI in the UK, significant CKD (eGFR<60 ml/min/1.73 m2) is common (17.6%) and ∼20% of the population are >75 years old. Whilst prescribing rates at discharge for β-blockers, ACE inhibitors and statins in those >75 years old were lower than for younger age groups, they were markedly better than those seen in historical datasets. Older studies suggest that only 23% patients with eGFR <45 ml/min/1.73 m2 received ACE inhibitors and β-blockers post-MI.3,5 This appeared to be the general trend irrespective of whether the population studied was from Europe or the USA. In our cohort, we found that >90% of patients were prescribed β-blocker and statin at discharge, although there still appears to be a reluctance to prescribe ACE inhibitors (76% at discharge).

The risk of CHD events and of adverse outcome thereafter increases with age. Perhaps as a result of associated co-morbidities, invasive intervention for coronary heart disease and use of secondary prevention medication following an ischaemic event is often sub optimal in the elderly. Recent reports from registry data have shown that revascularization even in the very elderly (octogenarians) can be achieved with relatively low rates of combined major adverse cardiovascular events comparable to younger age groups.12–14 The current study suggests that the same is true of secondary prevention pharmacological therapy after STEMI.

We had speculated that secondary prevention therapy would be more uniformly prescribed after PPCI, compared with historical datasets. We hypothesized that having delivered timely revascularization, there would be greater motivation to actively initiate and up-titrate secondary prevention drugs irrespective of co-morbidity. The current data support this hypothesis, and overall utilization of evidence-based secondary prevention is good.

However there remains some residual influence of age and renal function on prescribing practice and reductions in the overall utilization of drugs is seen over time. With increasing age and falling eGFR, the proportion of patients prescribed each secondary prevention agent fell. Patients with eGFR <45 ml/min/1.73 m2 received a ramipril equivalent dose that was slightly higher than those with eGFR >60 ml/min/1.73 m2. Whilst it is possible that it reflects the presence of other risk factors like hypertension/diabetes, it also suggests that when used it appears to be tolerated to a similar extent to that seen for lesser stages of CKD.

Around half of the patients had renal function reassessed on Day 3 post-PPCI; there are a number of plausible reasons, such as the presence of co-morbidities, preserved baseline renal function, uncomplicated PPCI and early discharge, as to why patients did not have repeat renal function assessment. The limited data on change in eGFR during hospital admission suggests that a reduction in renal function was associated with reduced ACE inhibitor/ ARB utilization and emphasizes the need to individualize therapy in this population.

Post-discharge monitoring of renal function following initiation and during up-titration of ACE inhibitor therapy is important to identify acute deterioration in renal function. In our study, while the withdrawal of ACE inhibitor was infrequent across the population as a whole, the proportion of patients with eGFR <45 ml/min/1.73 m2 prescribed ACE inhibitor/ARB had fallen to 66% at follow-up, compared with 76% at discharge. The specific reasons for this were beyond the scope of our current study. In comparison, age had relatively less influence on drug discontinuation. In patients continuing on treatment, mean dosages were similar at discharge and follow-up suggesting that little (if any) attempt has been made to up-titrate the drugs. As the risk of adverse event after STEMI is greatest in the early post-MI period, and in the context of early up-titration of therapy in clinical trials of ACEI/ARB or β-blocker, our observations have implications for the delivery of optimal secondary prevention after STEMI.

Gale et al.15 analysed data on 616 011 patients hospitalized with acute coronary syndrome (ACS) from the Myocardial Ischaemia National Audit Project (MINAP) dataset (1 January 2003 to 2 October 2010) and in this study, only 53% of the 75- to 84-year old and 46% of the >85-year-old patients were discharged on β-blockers. A similar pattern was seen for ACE inhibitors at 59% and 49%, respectively. There seemed to be slightly less inhibition in prescribing statins; 70% of the 75- to 84-year old and 59% of the >85-year-old patients were discharged on statins. In contrast, in the 65- to 74-year age group (which formed the bulk of the study population) 60% received β-blockers, 64.5% ACE inhibitors and 75% statins. The dataset in this case includes all ACS patients, many of whom would not have received timely angioplasty and again there were no follow-up data available. We speculate that timely angioplasty in our patients, regardless of co-morbidities, removed the fear of initiating drug therapy and translated to better utilization of secondary prevention. Patients post-angioplasty would generally be under the care of specialists.

The data on ARB use are interesting but limited due to small numbers. There appears to be more confidence in using these agents over ACE inhibitors in the elderly or in those with worst renal function. One might hypothesize that enhanced tolerability plays a part, although a misguided belief that they are more ‘renal friendly’ might also be relevant.

Our observations are limited by the restrictions inherent in any registry-based analysis. However, in order to minimize bias and to portray a representative overview of UK practice, we recruited consecutive patients across five geographically disparate PPCI centres in the UK. Historical data regarding this population (STEMI) is likely to be biased—the decision not to thrombolyse was often made based on frailty, co-morbidities or other issues. As such we chose to not explore historic data from STEMI patients receiving thrombolysis as a comparator group. Furthermore, the key aim of this article was to establish a current UK benchmark. Comprehensive co-morbidities, previous drug history and reasons why patients did not receive prognostically beneficial drugs e.g. blood pressure, pulse rate and change in eGFR post-discharge were not available. This in part was due to the fact that data were recorded in different formats at each centre and our objective was to get a large number of subjects from several centres to give a better representative overview. Further prospective evaluation is required to look at these factors as well as longer term effects in more detail.

Conclusions and clinical implications

Taken in entirety, the overall utilization of secondary prevention was very good in our primary angioplasty population with commendable use of β-blockers, ACE inhibitors and statins in the elderly and in those with CKD. There may however be room to improve even with the use of ACE inhibitors in those with worst CKD stage. These decisions should be made carefully on an individual basis, with close monitoring of renal function once initiated. Where difficulties are encountered, it may be that a lower dose will have to be accepted or titration may have to be slower. This is particularly important for those at greatest risk, such as patients with impaired left ventricular function and/or CKD. With the inevitable pressure on hospital beds and therefore often short hospital stays post-MI, it is crucial we do not compromise the medical management of such patients.

Funding

Conflict of interest: None declared.

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APPENDIX

Table A1

Data comparing secondary prevention utilization in the same cohort of patients seen at discharge as well as at 6 week follow-up post-angioplasty; classification as per age

Age group (nΒ-blocker use (%)
 
Mean Bisoprolol dose (mg)
 
ACE (i)/ ARB use (%)
 
Mean Ramipril dose (mg)
 
Statin use (%)
 
F/U P-value F/U P-value F/U P-value F/U P-value F/U 
<60 years (212) 93 91 0.81 3.4 3.3 0.98 97 96 0.93 3.5 3.3 0.89 99 97 
60-75 years (243) 93 90 0.74 3.5 3.6 0.95 95 91 0.70 3.8 3.8 1.0 98 96 
>75 years (112) 87 86 0.89 3.2 3.2 1.0 82 83 0.93 3.4 3.4 0.996 92 93 
Age group (nΒ-blocker use (%)
 
Mean Bisoprolol dose (mg)
 
ACE (i)/ ARB use (%)
 
Mean Ramipril dose (mg)
 
Statin use (%)
 
F/U P-value F/U P-value F/U P-value F/U P-value F/U 
<60 years (212) 93 91 0.81 3.4 3.3 0.98 97 96 0.93 3.5 3.3 0.89 99 97 
60-75 years (243) 93 90 0.74 3.5 3.6 0.95 95 91 0.70 3.8 3.8 1.0 98 96 
>75 years (112) 87 86 0.89 3.2 3.2 1.0 82 83 0.93 3.4 3.4 0.996 92 93 

D- Discharge, F/U- Follow-up.

Table A2

Data comparing secondary prevention utilization in the same cohort of patients seen at discharge as well as at 6 week follow-up post-angioplasty; classification as per eGFR in ml/min/1.73 m2

Renal function (n) Β-blocker use (%)
 
Mean Bisoprolol dose (mg)
 
ACE (i)/ ARB use (%)
 
Mean Ramipril dose (mg)
 
Statin use (%)
 
F/U P-value F/U P-value F/U P-value F/U P-value F/U 
eGFR≥60 (464) 94 90 0.71 3.4 3.4 0.996 94 92 0.82 3.6 3.7 0.996 98 96 
eGFR 45-59rs (74) 87 86 0.93 3.1 3.1 0.995 92 89 0.74 3.6 3.6 1.0 95 96 
eGFR <45 (29) 84 86 0.86 3.8 3.8 1.0 72 66 0.47 3.2 3.2 1.0 91 90 
Renal function (n) Β-blocker use (%)
 
Mean Bisoprolol dose (mg)
 
ACE (i)/ ARB use (%)
 
Mean Ramipril dose (mg)
 
Statin use (%)
 
F/U P-value F/U P-value F/U P-value F/U P-value F/U 
eGFR≥60 (464) 94 90 0.71 3.4 3.4 0.996 94 92 0.82 3.6 3.7 0.996 98 96 
eGFR 45-59rs (74) 87 86 0.93 3.1 3.1 0.995 92 89 0.74 3.6 3.6 1.0 95 96 
eGFR <45 (29) 84 86 0.86 3.8 3.8 1.0 72 66 0.47 3.2 3.2 1.0 91 90 

D- Discharge, F/U- Follow-up.