Abstract 121: Statin Use For Secondary Prevention Of Coronary Artery Disease In Patients Undergoing Repeat Percutaneous Coronary Intervention: Real World Data
Background: Secondary prevention with statin therapy in Coronary artery disease (CAD) decreases future major cardiovascular events and mortality and improves outcomes. Current guidelines recommend a LDL goal of at least ≤ 100 and preferably ≤ 70 . Statins have also shown to have beneficial effects independent of LDL levels. We hypothesized that is the real world statin use and LDL goal in CAD patients who need a subsequent percutaneous coronary intervention (PCI) is inadequate in spite of strong recommendations and guidelines Methods: A query of electronic medical records (EMR) in our 1100 bed academic community hospital retrieved 8586 PCIs from 10/1/2006 to 2/14/2012. Of these 1641 patients had definite CAD (defined by either a prior PCI or CABG) and only 1315 had lipid levels drawn within three months prior to PCI and patient (pts) data was retrieved from our PCI database and EMR. Results: Only 573 (44%) patients were on statins on arrival for PCI .However, 1187(90%) patients were prescribed statins on discharge from the cardiac catheterization lab and this was independent of the experience of the interventional cardiologists. Only 26% (346) patients had LDL≤ 70 and only 55% (727 ) patients had LDL ≤ 100. Patients with LDL not at goal were less likely to be on statins or any lipid lowering medications. Patients with renal failure were less likely to be on stains. However there was no significant difference in comorbidities(except hypertension)like alcohol abuse, liver failure, arthritis, obesity or depression in patients whether on or not on therapy with statins. Conclusions: Real world data shows that we fail at adequate usage of statins or getting lipids to target goals. Interestingly around 90% of patients are prescribed statins on discharge from the cardiac catheterization lab. In practice statins are discontinued or higher doses to achieve target LDLs are avoided as they are generally less well tolerated due to side effects (muscle and liver toxicity). In this subset of patients, referral to lipid specialists and specialty centers and advent of newer lipid lowering drugs may prove to be beneficial.