Secondary prevention is as important as primary management in the care of patients with acute coronary syndrome (ACS).
To describe prescription at discharge in patients admitted for an ACS in 3 population registers.
Patients aged 35–74 years old admitted for ACS in the regions covered by the French MONICA registers (Bas-Rhin, BR; Haute-Garonne, HG; Urban community of Lille, UCL) between 01/10/2015 and 31/03/2016, alive at discharge, were included. Prescription rates for dual antiplatelet therapy (DAPT: aspirin+ticagrelor/clopidogrel/prasugrel), b-blockers (BB), angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs), statins, and the combination of the 4 drugs were calculated. Statistical differences were assessed using logistic regressions adjusted for region, age, sex, ST-elevation, type of revascularisation, cardiovascular risk factors, and comorbidities.
A total of 1439 patients were included (77.6% men, median age 61.1). Prescription rates at discharge were 87% for DAPT, 85% for BB, 75% for ACEI/ARBs, 92% for statins, and 57% for all 4 drugs. For patients treated with percutaneous transluminal coronary angioplasty (PCTA), DAPT prescription was less frequent in HG compared to BR (Table 1). BB and ACEI/ARBs were less often prescribed in HG than in BR, and when a conservative treatment (CT: no PCTA nor coronary artery bypass grafting, CABG) was chosen over PCTA. Their prescription was more frequent in patients with ST-elevation. Prescription of statins was less frequent for patients with CT compared to patients with PCTA. All 4 drugs were less prescribed in the HG region than in BR. This was also observed for patients with CT or CABG compared to those with PCTA. Conversely, patients with ST-elevation were more frequently discharged with all 4 drugs compared to patients with no ST-elevation.
Prescriptions at discharge in patients admitted for an ACS still vary and need to be harmonised.Le texte complet de cet article est disponible en PDF.