Optimal medical therapy for secondary prevention after an acute coronary syndrome: 18-month follow-up results at a tertiary teaching hospital in South Korea

Figures & data

Figure 1 Flow diagram of steps in the selection of study subjects.

Abbreviations: ACS, acute coronary syndrome; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.

Table 1 Characteristics of study subjects according to types of ACS

Variable	All patients (n=494)	UA (n=254)	NSTEMI (n=62)	STEMI (n=178)	P-value
Age (year), mean ± SD	67.71±10.92	68.17±10.48	70.69±10.54	66.01±11.43	0.0077
<60, n (%)	125 (25.30)	55 (21.65)	12 (19.35)	58 (32.58)	0.0106
60–74, n (%)	229 (46.36)	128 (50.40)	24 (38.71)	77 (43.26)
≥75, n (%)	140 (28.34)	71 (27.95)	26 (41.94)	43 (24.16)
Sex
Male, n (%)	327 (66.19)	148 (58.27)	43 (69.35)	136 (76.40)	0.0004
Female, n (%)	167 (33.81)	106 (41.73)	19 (30.65)	42 (23.60)
Demographic characteristics
Height (cm), mean ± SD	164.48±9.08	163.21±9.17	159.98±11.37	166.69±7.88	0.0858
Weight (kg), mean ± SD	65.71±11.96	66.64±9.6	57.36±10.43	67.24±13.28	0.0708
BMI (kg/m^2), mean ± SD	24.2±3.27	25.02±2.84	22.31±2.78	24.07±3.53	0.0718
Risk factors
Diabetes, n (%)	199 (40.28)	90 (35.43)	31 (50.00)	78 (43.82)	0.0539
Hypertension, n (%)	306 (61.94)	170 (66.93)	40 (64.52)	96 (53.93)	0.0213
Hyperlipidemia, n (%)	176 (35.63)	90 (35.43)	32 (51.61)	54 (30.34)	0.0107
Renal failure, n (%)	38 (7.69)	13 (5.12)	7 (11.29)	18 (10.11)	0.0834
Current smoker, n (%)	158 (31.98)	55 (21.65)	18 (29.03)	85 (47.75)	<0.0001
Family history, n (%)	94 (19.03)	45 (17.72)	12 (19.35)	37 (20.79)	0.7243
Obesity, n (%)	1 (0.20)	1 (0.39)	–	–	0.6229
Underlying diseases
Previous MI, n (%)	83 (16.80)	32 (12.60)	9 (14.52)	42 (23.60)	0.0095
Previous HF, n (%)	33 (6.68)	16 (6.30)	6 (9.68)	11 (6.18)	0.5993
Previous CABG, n (%)	11 (2.23)	6 (2.36)	2 (3.23)	3 (1.69)	0.7614
Previous PCI, n (%)	443 (89.68)	214 (84.25)	55 (88.71)	174 (97.75)	<0.0001
Previous stroke/TIA, n (%)	26 (5.26)	9 (3.54)	5 (8.06)	12 (6.74)	0.1956

Abbreviations: ACS, acute coronary syndrome; CABG, coronary artery bypass graft; HF, heart failure; MI, myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; SD, standard deviation; STEMI, ST-segment elevation myocardial infarction; TIA, transient ischemic attack; UA, unstable angina.

Table 2 Prescription frequency of the five medications for ACS secondary prevention according to the characteristics of study subjects

Variable	Aspirin (n=485)	Clopidogrel (n=445)	ACE-I/ARB (n=455)	β-Blocker (n=438)	Statin (n=456)
Age (year), mean ± SD	67.72±10.99	67.55±10.86	67.42±10.9	67.32±10.74	67.76±11
<60, n (%)	124 (25.57)	113 (25.39)	118 (25.93)	114 (26.03)	119 (26.10)
60–74, n (%)	221 (45.57)	209 (46.97)	207 (45.49)	206 (47.03)	214 (46.93)
≥75, n (%)	140 (28.86)	123 (27.64)	130 (28.58)	118 (26.94)	123 (26.97)
Sex
Male, n (%)	321 (66.19)	306 (68.76)	303 (66.59)	290 (66.21)	307 (67.32)
Female, n (%)	164 (33.81)	139 (31.24)	152 (33.41)	148 (33.79)	149 (32.68)
Types of ACS
UA, n (%)	246 (50.72)	213 (47.87)	229 (50.33)	218 (49.77)	229 (50.22)
NSTEMI, n (%)	61 (12.58)	58 (13.03)	60 (13.19)	52 (11.87)	54 (11.84)
STEMI, n (%)	178 (36.70)	174 (39.10)	166 (36.48)	168 (38.36)	173 (37.94)

Abbreviations: ACE-I, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin II receptor blocker; NSTEMI, non-ST-segment elevation myocardial infarction; SD, standard deviation; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.

Table 3 Prescription patterns for the five medications for ACS secondary prevention according to types of ACS

Regimen	All patients (n=494)	UA (n=254)	NSTEMI (n=62)	STEMI (n=178)
Aspirin + statin, n (%)	4 (0.81)	3 (1.18)	1 (1.61)	–
Clopidogrel + statin, n (%)	2 (0.40)	2 (0.79)	–	–
Aspirin + clopidogrel + statin, n (%)	6 (1.21)	3 (1.18)	–	3 (1.69)
Aspirin + β-blocker, n (%)	1 (0.20)	1 (0.39)	–	–
Aspirin + clopidogrel + β-blocker, n (%)	2 (0.40)	1 (0.39)	–	1 (0.56)
Aspirin + ACE-I/ARB, n (%)	5 (1.01)	4 (1.57)	1 (1.61)	–
Aspirin + clopidogrel + ACE-I/ARB, n (%)	2 (0.40)	1 (0.39)	1 (1.61)	–
Aspirin + β-blocker + statin, n (%)	4 (0.81)	4 (1.57)	–	–
Aspirin + clopidogrel + β-blocker + statin, n (%)	16 (3.24)	7 (2.76)	1 (1.61)	8 (4.49)
Aspirin + ACE-I/ARB + statin, n (%)	7 (1.42)	6 (2.36)	–	1 (0.56)
Clopidogrel + ACE-I/ARB + statin, n (%)	2 (0.40)	2 (0.79)	–	–
Aspirin + clopidogrel + ACE-I/ARB + statin, n (%)	25 (5.06)	12 (4.72)	7 (11.29)	6 (3.37)
Aspirin + β-blocker + ACE-I/ARB + statin, n (%)	15 (3.04)	13 (5.12)	–	2 (1.12)
Aspirin + clopidogrel + β-blocker + ACE-I/ARB + statin, n (%)	374 (75.71)	177 (69.69)	44 (70.97)	153 (85.96)

Abbreviations: ACE-I, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin II receptor blocker; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.

Table 4 Appropriateness of discharge medications for ACS secondary prevention according to the characteristics of study subjects

Variable	All patients (n=494)	Guideline adherence (n=374)	Incomplete guideline adherence (n=120)	P-value
Age (year), mean ± SD	67.71±10.92	70.23±10.45	66.90±10.96	0.0044
<60, n (%)	125 (25.30)	106 (28.34)	19 (15.83)	0.0117
60–74, n (%)	229 (46.36)	171 (45.72)	58 (48.33)
≥75, n (%)	140 (28.34)	97 (25.94)	43 (35.83)
Sex
Male, n (%)	327 (66.19)	257 (68.72)	70 (58.33)	0.0364
Female, n (%)	167 (33.81)	117 (31.28)	50 (41.67)
Types of ACS
UA, n (%)	254 (51.42)	177 (47.33)	77 (64.17)	0.0003
NSTEMI, n (%)	62 (12.55)	44 (11.76)	18 (15.00)
STEMI, n (%)	178 (36.03)	153 (40.91)	25 (20.83)

Note: Guideline adherence indicates that all five drugs (ie, aspirin, P2Y₁₂ receptor inhibitor, statin, β-blocker, and ACE-I/ARB) were prescribed to patients discharged after ACS treatment.

Abbreviations: ACE-I, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin II receptor blocker; NSTEMI, non-ST-segment elevation myocardial infarction; SD, standard deviation; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.

Table 5 Prescription frequency of the five medications for ACS secondary prevention at discharge and 3, 6, 12, and 18 months after discharge

Variable	At discharge, (n=494)	3-month f/u, (n=494)	6-month f/u, (n=494)	12-month f/u, (n=494)	18-month f/u, (n=494)
Aspirin, n (%)	485 (98.18)	448 (90.69)	476 (96.36)	478 (96.76)	480 (97.17)
Clopidogrel, n (%)	445 (90.08)	363 (73.48)	331 (67.00)	247 (50.00)	173 (35.02)
ACE-I/ARB, n (%)	455 (92.11)	385 (77.94)	395 (79.96)	394 (79.76)	387 (78.34)
β-Blocker, n (%)	438 (88.66)	392 (79.35)	411 (83.20)	401 (81.17)	394 (79.76)
Statin, n (%)	456 (92.31)	401 (81.17)	418 (84.62)	425 (86.03)	425 (86.03)
All five drugs, n (%)	374 (75.71)	251 (50.81)	229 (46.36)	169 (34.21)	105 (21.26)

Note: All five drugs include aspirin, P2Y₁₂ receptor inhibitor, ACE-I/ARB, β-blocker, and statin.

Abbreviations: ACE-I, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin II receptor blocker; f/u, follow-up.

Table 6 Prescription patterns for the five medications for ACS secondary prevention at discharge and 3, 6, 12, and 18 months after discharge

Regimen	At discharge, (n=494)	3-month f/u, (n=494)	6-month f/u, (n=494)	12-month f/u, (n=494)	18-month f/u, (n=494)
Aspirin + statin, n (%)	4 (0.81)	5 (1.01)	8 (1.62)	12 (2.43)	14 (2.83)
Clopidogrel + statin, n (%)	2 (0.40)	–	–	–	–
Aspirin + clopidogrel + statin, n (%)	6 (1.21)	5 (1.01)	6 (1.21)	4 (0.81)	5 (1.01)
Aspirin + β-blocker, n (%)	1 (0.20)	4 (0.81)	5 (1.01)	5 (1.01)	5 (1.01)
Aspirin + clopidogrel + β-blocker, n (%)	2 (0.40)	3 (0.61)	4 (0.81)	3 (0.61)	5 (1.01)
Aspirin + ACE-I/ARB, n (%)	5 (1.01)	2 (0.40)	5 (1.01)	7 (1.42)	7 (1.42)
Clopidogrel + ACE-I/ARB, n (%)	–	–	–	1 (0.20)	1 (0.20)
Aspirin + clopidogrel + ACE-I/ARB, n (%)	2 (0.40)	2 (0.40)	3 (0.61)	3 (0.61)	3 (0.61)
Aspirin + β-blocker + statin, n (%)	4 (0.81)	17 (3.44)	27 (5.47)	44 (8.91)	52 (10.53)
Aspirin + clopidogrel + β-blocker + statin, n (%)	16 (3.24)	34 (6.88)	32 (6.48)	18 (3.64)	18 (3.64)
Aspirin + ACE-I/ARB + statin, n (%)	7 (1.42)	17 (3.44)	21 (4.25)	35 (7.09)	48 (9.72)
Clopidogrel + ACE-I/ARB + statin, n (%)	2 (0.40)	–	–	–	–
Aspirin + clopidogrel + ACE-I/ARB + statin, n (%)	25 (5.06)	28 (5.67)	21 (4.25)	15 (3.04)	12 (2.43)
Aspirin + β-blocker + ACE-I/ARB + statin, n (%)	15 (3.04)	38 (7.69)	71 (14.37)	123 (24.90)	163 (33.00)
Clopidogrel + β-blocker + ACE-I/ARB + statin, n (%)	–	2 (0.40)	–	–	3 (0.61)
Aspirin + clopidogrel + β-blocker + ACE-I/ARB + statin, n (%)	374 (75.71)	251 (50.81)	229 (46.36)	169 (34.21)	105 (21.26)

Abbreviations: ACE-I, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin II receptor blocker; f/u, follow-up.