Predictors of Evidence-based Therapy Prescription in Acute Coronary Syndrome—Observations from the Australian and New Zealand GRACE Registry

Predictors of Evidence-based Therapy Prescription in Acute Coronary Syndrome—Observations from the Australian and New Zealand GRACE Registry

S120 Heart, Lung and Circulation 2009;18S:S1–S286 Abstracts ABSTRACTS 98–158, n = 14, p = 0.015). Post-PCI, MPO at CS was higher in STEMI vs. cont...

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S120

Heart, Lung and Circulation 2009;18S:S1–S286

Abstracts

ABSTRACTS

98–158, n = 14, p = 0.015). Post-PCI, MPO at CS was higher in STEMI vs. controls (154.4, 118–216 vs. 90, 70–124, p = 0.002). Conclusion: Elevated plasma MPO locally at culprit coronary lesion in STEMI suggests a possible role of MPO in the aetiology of acute plaque rupture and occlusive thrombus formation. doi:10.1016/j.hlc.2009.05.270 269 POPULATION ATTRIBUTABLE FRACTION OF MAJOR CORONARY EVENTS DUE TO CHRONIC ISCHEMIC HEART DISEASE (IHD) HIGHLIGHTS THE IMPORTANCE OF SECONDARY PREVENTION T. Briffa 1 , S. Hobbs 1 1 The

Ridout 1 , A.

Tonkin 2 , F.

Sanfilippo 1 , M.

University of Western Australia, Perth, Australia University, Melbourne, Australia

2 Monash

Background: Persons with manifest IHD are at much higher risk of future IHD events or death than apparently healthy people and are thus a major target for secondary prevention. However, the prevalence of chronic IHD and proportion of major IHD events (hospitalized MI + IHD death) it contributes in Australia is unknown. Methods: We used data linkage to determine in 1995–2003 the prevalence of persons aged 35–84 years ever admitted to hospital for IHD in the previous 15 years and to identify major IHD events (as defined) in the prevalent and disease free populations. Results: From 1995 to 2005, there were 20,917 incident and 16,981 recurrent major IHD events in the study population. The proportion of IHD events occurring in those with a history of IHD in 1995–1997 was 48.3% compared with 42.5% in 2003–2005. For total IHD deaths the respective proportions were 65% and 55% and for non-fatal MI, 33% and 35%. The prevalence of previous IHD in men in 1995–1997 was 8.3%, falling to 8.2% in 2003–2005. In women the prevalence fell from 4.2% to 4.0% for the same periods. Prevalence rose strongly with age from <1% to 43% at 80–84 year old men and to 23% in women. Conclusion: In 1995–1997, about half of nonfatal and fatal IHD events occurred in those still alive after previous hospitalisation with IHD. By 2004–2005 this proportion has declined somewhat, but the need for more effective secondary preventive after discharge from hospital for IHD and related conditions is still very apparent. doi:10.1016/j.hlc.2009.05.271

Fig. 1. Difference between actual vs GRS predicted 6 month mortality.

270 PREDICTORS OF EVIDENCE-BASED THERAPY PRESCRIPTION IN ACUTE CORONARY SYNDROME—OBSERVATIONS FROM THE AUSTRALIAN AND NEW ZEALAND GRACE REGISTRY V. Chow 1 , I. Ranasinghe 1 , B. Aliprandi-Costa 1 , J. 2 3 4 Lefkovits , J. Waites , C. Juergens , D. Brieger 1 1 Concord

Hospital, Sydney, Australia Melbourne Hospital, Melbourne, Australia 3 Coffs Harbour Hospital, Coffs Harbour NSW, Australia 4 Liverpool Hospital, Sydney, Australia 2 Royal

Background: In acute coronary syndrome (ACS), adherence to evidence-based therapies (EBTs) following discharge correlates with reduced mortality. Few studies assess predictors of EBTs prescription at discharge and 6-month mortality outcomes. Aim: To examine predictors of EBTs prescription at discharge and the relationship between number of EBTs prescribed and 6-month mortality. Method: Analysis of 4444 Australia and New Zealand ACS patients enrolled in the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 for whom 6 month follow-up data were available. Optimal therapy was regarded as prescription of at least 4 of the 5 EBTs at discharge. Result: Optimal EBTs were prescribed in 51.9%. Patients undergoing CABG (OR 0.32, CI 0.23–0.44), age > 70 (OR 0.66, CI 0.54–0.81), atrial fibrillation (AF) at any time (OR 0.70, CI 0.52–0.93) were negative predictors of ≥4 EBTs. Significant reductions in 6-month mortality correlated with increasing number of EBTs from 0/1: 9.2%, 2: 8.2%, 3: 4.8%, 4/5: 2% (p < 0.0001 and p for trend <0.0001). This was partly explained by an inverse relationship between GRS and number of EBTs prescribed (EBTs < 4: GRS 127.43 vs EBTs ≥ 4: GRS 115.97, p < 0.0001). However actual vs predicted mortality fell steadily as number of EBTs increased (Fig. 1). Conclusion: Optimal discharge EBT is offered to only 50% of ACS patients in this cohort. Predictors of prescription of <4 EBTs include CABG, age >70 and atrial fibrillation. A reduction in actual vs predicted mortality was observed as number of EBTs increased. doi:10.1016/j.hlc.2009.05.272