Table 1
Baseline characteristics for all patients and by prescription pattern.
| Patient Characteristics | All patients (n = 10,067) | GDPM (n = 4,540) | Non-GDPM (n = 5,527) | p-value |
|---|---|---|---|---|
| Demographic characteristics | ||||
| Age, years | 58 ± 10 | 58 ± 10 | 58 ± 10. | 0.075 |
| ≤65, n (%) | 7,564 (75.1) | 3,398 (74.8) | 4,166 (75.4) | 0.541 |
| 66–79, n (%) | 2,374 (23.6) | 1,097 (24.2) | 1,277 (23.1) | 0.213 |
| ≥80*†, n (%) | 129 (1.3) | 45 (1.0) | 84 (1.5) | 0.019 |
| Female*, n (%) | 2,310 (22.9) | 1,002 (22.1) | 1,308 (23.7) | 0.058 |
| Clinical characteristics | ||||
| Admission presentation*†, n (%) | ||||
| Stable CAD | 4,021 (39.9) | 1,747 (38.5) | 2,274 (41.1) | 0.007 |
| NSTE-ACS | 4,709 (46.8) | 1,956 (43.1) | 2,753 (49.8) | <0.001 |
| STEMI | 1,337 (13.3) | 837 (18.4) | 500 (9.0) | <0.001 |
| BMI*†, kg/m2 | 25.9 ± 3.2 | 26.2 ± 3.1 | 25.7 ± 3.20 | <0.001 |
| <18.5, n (%) | 85 (0.8) | 32 (0.7) | 53 (1.0) | 0.166 |
| 18.5–24.9, n (%) | 3,791 (37.7) | 1,568 (34.5) | 2,223 (40.2) | <0.001 |
| 25.0–29.9, n (%) | 5,175 (51.4) | 2,424 (53.4) | 2,751 (49.8) | <0.001 |
| ≥30.0, n (%) | 1,016 (10.1) | 516 (11.4) | 500 (9.0) | <0.001 |
| Current smoke, n (%) | 5,740 (57.0) | 2,619 (57.7) | 3,121 (56.5) | 0.219 |
| Diabetes*†, n (%) | 3,009 (29.9) | 1,482 (32.6) | 1,527 (27.6) | <0.001 |
| Insulin use*, n (%) | 1,302 (12.9) | 636 (14.0) | 666 (12.0) | 0.004 |
| Hypertension*†, n (%) | 6,475 (64.3) | 3,512 (77.4) | 2,963 (53.6) | <0.001 |
| Hyperlipidaemia*, n (%) | 6,748 (67.0) | 3,127 (68.9) | 3,621 (65.5) | <0.001 |
| COPD, n (%) | 230 (2.3) | 98 (2.2) | 132 (2.4) | 0.443 |
| PAD, n (%) | 263 (2.6) | 116 (2.6) | 147 (2.7) | 0.743 |
| Prior MI*†, n (%) | 1,894 (18.8) | 1,062 (23.4) | 832 (15.1) | <0.001 |
| Prior stroke*, n (%) | 1,065 (10.6) | 516 (11.4) | 549 (9.9) | 0.020 |
| Prior PCI*, n (%) | 2,394 (23.8) | 1,175 (25.9) | 1,219 (22.1) | <0.001 |
| Prior CABG*, n (%) | 399 (4.0) | 187 (4.1) | 212 (3.8) | 0.469 |
| Haemoglobin, g/L | 143 ± 15 | 144 [133, 154] | 144 [133, 154] | 0.829 |
| Anaemia, n (%) | 351 (3.5) | 162 (3.6) | 189 (3.4) | 0.686 |
| Platelet*, 109/L | 200 [168, 236] | 204 [171, 240] | 197 [165, 233] | <0.001 |
| Thrombocytopenia, n (%) | 70 (0.7) | 29 (0.6) | 41 (0.7) | 0.536 |
| Total cholesterol*, mmol/L | 4.06 [3.45, 4.81] | 4.07 [3.45, 4.81] | 4.05 [3.44, 4.81] | 0.552 |
| HDL-C*, mmol/L | 1.00 [0.84, 1.18] | 0.98 [0.83, 1.16] | 1.01 [0.85, 1.20] | <0.001 |
| LDL-C*, mmol/L | 2.36 [1.86, 3.02] | 2.36 [1.88, 3.00] | 2.35 [1.84, 3.03] | 0.755 |
| Triglyceride*, mmol/L | 1.53 [1.14, 2.11] | 1.58 [1.19, 2.16] | 1.50 [1.10, 2.07] | <0.001 |
| Lp(a), mg/L | 186.18 [78.51, 412.98] | 188.19 [78.49, 418.59] | 184.16 [78.39, 407.55] | 0.412 |
| Creatinine*, μmol/L | 74.0 [65.3, 83.4] | 74.4 [65.6, 84.4] | 73.7 [65.1, 82.4] | <0.001 |
| eGFR, ml/min | 94.1 [83.6, 101.7] | 93.8 [82.4, 101.8] | 94.4 [84.4, 101.6] | 0.036 |
| <60.0* | 398 (4.0) | 196 (4.3) | 202 (3.7) | 0.090 |
| LVEF, % | 64 [60, 67] | 63 [59, 67] | 64 [60, 68] | <0.001 |
| <40*, n (%) | 118 (1.2) | 66 (1.0) | 52 (1.4) | 0.017 |
| Angiographic characteristics | ||||
| Multivessel disease*, n (%) | 7,252 (72.0) | 3,376 (74.4) | 3,876 (70.1) | <0.001 |
| Left main disease*, n (%) | 108 (1.1) | 39 (0.9) | 69 (1.2) | 0.059 |
| Number of stents*† | 2 [1, 2] | 2 [1, 2] | 2 [1, 2] | 0.001 |
| Type of stent | ||||
| ≥1 DES, n (%) | 10,030 (99.6) | 4,523 (99.6) | 5,507 (99.6) | 0.917 |
[i] Values are mean ± standard deviation, number (%) or median [interquartile range].
GDPM, guideline-directed secondary prevention medication; CAD, coronary artery disease; NSTE-ACS, non-ST-segment elevation acute coronary syndrome; STEMI, ST-segment elevation myocardial infarction; BMI, body mass index; COPD, chronic obstructive pulmonary disease; PAD, peripheral artery disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein (a); eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction; DES, drug-eluting stent.
* Candidate variables selected for the multivariable logistic model.
† Risk-adjusting variables selected for multivariable Cox models.
Figure 1
Flow chart of the study population. PCI, percutaneous coronary intervention; GDPM, guideline-directed secondary prevention medication.
Figure 2
Adjusted ORs and 95% CIs for the likelihood of receiving guideline-directed secondary prevention medication. OR, odds ratio; CI, confidence interval; NSTE-ACS, non-ST-segment elevation acute coronary syndrome; CAD, coronary artery disease; STEMI, ST-segment elevation myocardial infarction; BMI, body mass index; MI, myocardial infarction.
Table 2
Cox regression analysis of GDPM on clinical outcomes.
| Outcome measure | GDPM (n = 4,540) | Non-GDPM (n = 5,527) | p-value | Unadjusted HR [95%CI] | p-value | Adjusted HR [95%CI] | p-value |
|---|---|---|---|---|---|---|---|
| 30 days | |||||||
| MACE | 69 (1.5) | 82 (1.5) | 0.882 | 1.025 [0.744, 1.411] | 0.882 | 1.019 [0.739, 1.403] | 0.910 |
| Cardiac death | 7 (0.2) | 6 (0.1) | 0.526 | 1.421 [0.478, 4.228] | 0.528 | 1.428 [0.478, 4.266] | 0.523 |
| MI | 58 (1.3) | 71 (1.3) | 0.975 | 0.995 [0.703, 1.407] | 0.975 | 0.991 [0.700, 1.402] | 0.959 |
| Unplanned 12revascularization | 14 (0.3) | 18 (0.3) | 0.878 | 0.947 [0.471, 1.904] | 0.879 | 0.965 [0.479, 1.944] | 0.920 |
| 2 years | |||||||
| MACE | 474 (10.4) | 656 (11.9) | 0.024 | 0.875 [0.777, 0.984] | 0.026 | 0.875 [0.777, 0.984] | 0.026 |
| Cardiac death | 34 (0.7) | 35 (0.6) | 0.484 | 1.184 [0.738, 1.898] | 0.483 | 1.156 [0.721, 1.855] | 0.547 |
| MI | 136 (3.0) | 198 (3.6) | 0.102 | 0.836 [0.672, 1.040] | 0.108 | 0.829 [0.666, 1.032] | 0.093 |
| Unplanned 12revascularization | 388 (8.5) | 551 (10.0) | 0.015 | 0.852 [0.748, 0.970] | 0.016 | 0.854 [0.750, 0.973] | 0.018 |
| 5 years | |||||||
| MACE | 732 (16.1) | 991 (17.9) | 0.017 | 0.890 [0.809, 0.979] | 0.017 | 0.889 [0.808, 0.978] | 0.016 |
| Cardiac death | 100 (2.2) | 110 (2.0) | 0.458 | 1.110 [0.847, 1.455] | 0.450 | 1.089 [0.831, 1.429] | 0.536 |
| MI | 285 (6.3) | 391 (7.1) | 0.112 | 0.887 [0.761, 1.033] | 0.123 | 0.884 [0.759, 1.030] | 0.113 |
| Unplanned 12revascularization | 573 (12.6) | 801 (14.5) | 0.006 | 0.862 [0.775, 0.960] | 0.007 | 0.864 [0.776, 0.962] | 0.008 |
[i] Events are expressed as number (%).
GDPM, guideline-directed secondary prevention medication; HR, hazard ratio; CI, confidence interval; MACE, major adverse cardiovascular event; MI, myocardial infarction.
Figure 3
Cumulative incidence curves for 30-day clinical outcomes by prescription pattern (A–D) (Orange for GDPM, blue for non-GDPM). Cumulative incidence curves for A) MACE, B) cardiac death, C) MI, D) unplanned revascularization. GDPM, guideline-directed secondary prevention medication; MACE, major adverse cardiovascular event; MI, myocardial infarction.
Figure 4
Cumulative incidence curves for five-year clinical outcomes by receipt of GDPM (A–D). (Orange for GDPM, blue for non-GDPM). Cumulative incidence curves for A) MACE, B) cardiac death, C) MI, D) unplanned revascularization. GDPM, guideline-directed secondary prevention medication; MACE, major adverse cardiovascular event; MI, myocardial infarction.