Elsevier

The American Journal of Cardiology

Volume 159, 15 November 2021, Pages 19-29
The American Journal of Cardiology

Effect of Polypharmacy on Long-Term Mortality After Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2021.08.013Get rights and content

Polypharmacy was reported to be associated with increased mortality in various populations. However, there is a scarcity of data on status of polypharmacy and association with long-term mortality in patients who underwent percutaneous coronary intervention (PCI). Among 12,291 patients who underwent first PCI in the CREDO-Kyoto PCI/CABG registry Cohort-3, we evaluated the number of medications at discharge from index PCI hospitalization, and compared long-term mortality across the 3 groups divided by the tertiles of the number of medications. The median number of medications was 6 (interquartile range: 5 to 8), and 88.0% of the patients were on >=5 medications. Most of medications were those related to cardiovascular disease. Patients taking more medications were older and more often had co-morbidities and guideline-indicated medications. The cumulative 5-year incidence of all-cause death increased incrementally with increasing number of medications (Tertile 1 [<=5]: 13.1%, Tertile 2 [6 to 7]: 13.9%, and Tertile 3 [>=8]: 18.0%, log-rank p <0.001). After adjusting confounders, the mortality risks of Tertile 2 and Tertile 3 relative to Tertile 1 were no longer significant (Tertile 2: hazard ratio 0.93; 95% confidence interval 0.84 to 1.04; p = 0.23, and Tertile 3: hazard ratio 0.91; 95% confidence interval 0.81 to 1.03; p = 0.14, respectively). In conclusion, in a real-world population of patients who underwent PCI, approximately 90% of patients were on >=5 medications. Increasing medications was associated with higher crude incidence of all-cause death, whereas adjusted mortality risks were similar regardless of the number of medications. These data might suggest that achievement of optimal medical therapy would be preferred, even if it might increase the number of medications used.

Section snippets

Methods

The Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG registry Cohort-3 is a physician-initiated, noncompany-sponsored, multicenter registry enrolling consecutive patients who underwent first coronary revascularization with PCI or isolated CABG without combined non-coronary surgery among 22 Japanese centers between January 2011 and December 2013 (Supplemental Appendix). The design and patient enrollment of the CREDO-Kyoto PCI/CABG registry Cohort-3 were

Results

Among the study population, the median number of medications was 6 (IQR: 5 to 8), and 10,821 patients (88.0%) had 5 or more medications (Figure 2). The detailed information of the medications was shown in Table 2. The median number of antithrombotic medications was 2, the median number of lipid modifying medications was 1, the median number of medications for hypertension and/or heart failure was 2, and the median number of medications for peptic ulcer was 1. Most of medications were those

Discussion

The main findings of this real-world study evaluating polypharmacy and long-term mortality in patients who underwent PCI were as follows; (1) The median number of medication at discharge from index PCI hospitalization was 6, and 88.0% of the patients were on >=5 medications; (2) Main medications consisted of antiplatelet medications, lipid modifying medications, medications for hypertension and/or heart failure, and medications for peptic ulcer, and there were only a few medications prescribed

Disclosures

Dr. Morimoto reports lecturer's fees from Bayer, Daiichi Sankyo, Japan Lifeline, Kyocera, Mitsubishi Tanabe, Novartis, and Toray, and the manuscript fees from Bristol-Myers Squibb and Kowa, and served advisory boards for Asahi Kasei, Boston Scientific, Bristol-Myers Squibb, and Sanofi. Dr. Shiomi reports personal fees from Abbott Vascular, Boston Scientific, and Daiichi Sankyo. Dr. Furukawa reports honoraria from Ono Pharmaceutical, Novartis, Daiichi Sankyo, Bayer, Otsuka Pharmaceutical, Kowa,

Acknowledgment

We appreciate the support and collaboration of the co-investigators participating in the CREDO-Kyoto PCI/CABG Registry Cohort-3. We are indebted to the clinical research coordinators for data collection.

References (12)

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Funding: This work was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan).

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