Medical therapy at discharge in patients admitted for acute coronary syndrome: Data of the French MONICA population registers

Background Secondary prevention is as important as primary management in the care of patients with acute coronary syndrome (ACS). Aim To describe prescription at discharge in patients admitted for an ACS in 3 population registers. Methods 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. Results 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. Conclusion Prescriptions at discharge in patients admitted for an ACS still vary and need to be harmonised.