Table 7.
Medication Prescription Rates Before and After Publication of COURAGE, Stratified by Before and After PCI and CCS Class
| Medication | No. (%), (95% CI) of Patients | P‐Value* | |
|---|---|---|---|
| Pre‐COURAGE | Post‐COURAGE | ||
| CCS class 0 to 2 (N=8284) | |||
| Pre‐PCI | |||
| Optimal medical therapy | 1775 (42.0%) | 1703 (41.9%) | 0.929 |
| Suboptimal medical therapy | 2151 (50.9%) | 2141 (52.7%) | 0.104 |
| None | 297 (7.0%) | 217 (5.3%) | 0.001 |
| Nitrate | 1042 (24.7%) | 875 (21.5%) | <0.001 |
| β‐Blocker | 2857 (67.7%) | 2726 (67.1%) | 0.609 |
| Calcium channel blocker | 1629 (38.6%) | 1659 (40.9%) | 0.034 |
| Statin | 3165 (74.9%) | 3209 (79.0%) | <0.001 |
| ACE‐I/ARB | 2957 (70.0%) | 2848 (70.1%) | 0.914 |
| Clopidogrel | 1339 (31.7%) | 1347 (33.2%) | 0.155 |
| Post‐PCI | |||
| Optimal medical therapy | 1728 (40.9%) | 1560 (38.4%) | 0.020 |
| Suboptimal medical therapy | 2440 (57.8%) | 2455 (60.5%) | 0.013 |
| None | 55 (1.3%) | 46 (1.1%) | 0.482 |
| Nitrate | 532 (12.6%) | 487 (12.0%) | 0.402 |
| β‐Blocker | 2823 (66.8%) | 2583 (63.6%) | 0.002 |
| Calcium channel blocker | 1400 (33.2%) | 1484 (36.5%) | 0.001 |
| Statin | 3515 (83.2%) | 3469 (85.4%) | 0.006 |
| ACE‐I/ARB | 3132 (74.2%) | 2863 (70.5%) | <0.001 |
| Clopidogrel | 3750 (88.8%) | 3677 (90.5%) | 0.009 |
| CCS Class 3 to 4 (N=15 396) | |||
| Pre‐PCI | |||
| Optimal medical therapy | 2413 (31.1%) | 2132 (27.9%) | <0.001 |
| Suboptimal medical therapy | 3842 (49.5%) | 3757 (49.2%) | 0.713 |
| None | 1506 (19.4%) | 1746 (22.9%) | <0.001 |
| Nitrate | 2167 (27.9%) | 1490 (19.5%) | <0.001 |
| β‐Blocker | 4249 (54.7%) | 3635 (47.6%) | <0.001 |
| Calcium channel blocker | 3059 (39.4%) | 2830 (37.1%) | 0.003 |
| Statin | 4545 (58.6%) | 4296 (56.3%) | 0.004 |
| ACE‐I/ARB | 4561 (58.8%) | 4396 (57.6%) | 0.134 |
| Clopidogrel | 1486 (19.1%) | 1194 (15.6%) | <0.001 |
| Post‐PCI | |||
| Optimal medical therapy | 3939 (50.8%) | 3922 (51.4%) | 0.445 |
| Suboptimal medical therapy | 3448 (44.4%) | 3248 (42.5%) | 0.018 |
| None | 374 (4.8%) | 465 (6.1%) | <0.001 |
| Nitrate | 1369 (17.6%) | 1038 (13.6%) | <0.001 |
| β‐Blocker | 5723 (73.7%) | 5600 (73.3%) | 0.579 |
| Calcium channel blocker | 2359 (30.4%) | 2077 (27.2%) | <0.001 |
| Statin | 6563 (84.6%) | 6481 (84.9%) | 0.579 |
| ACE‐I/ARB | 5961 (76.8%) | 5682 (74.4%) | <0.001 |
| Clopidogrel | 6640 (85.6%) | 6562 (85.9%) | 0.488 |
Optimal medical therapy is defined as prescription for β‐blocker, statin, and either ACE‐inhibitor or ARB in the 90 days prior to PCI, and the same medications along with a thienopyridine in the 90 days following PCI. Suboptimal therapy is defined as prescription of at least 1 of the above individual medications.
ACE‐I indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCS, Canadian Cardiovascular Society; COURAGE, Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; PCI, percutaneous coronary intervention.
*
McNemar test.