Percutaneous coronary intervention vs. optimal medical therapy – the other side of the coin: medication adherence C. Kocas MD, O. Abaci MD, V. Oktay MD, U. Coskun MD, C. Bostan MD, A. Yildiz MD, A. Arat Ozkan MD, T. Gurmen MD and M. Ersanli MD Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey Received 5 May 2013, Accepted 18 July 2013 Keywords: coronary artery disease, medication adherence, optimal medical therapy, percutaneous coronary intervention SUMMARY What is known and objective: Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence-based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone. Methods: We evaluated adherence to statins, beta-blockers, and angiotensin converting enzyme inhibitors (ACEI) during a 6- month follow-up in 232 patients with documented CAD, comparing patients treated with PCI and those receiving medical therapy alone. Medication adherence was measured with refer- ence to national reimbursement database records. Results and discussion: Of the 232 patients who survived the 6- month follow-up, the percentages of adherent patients according to prescription records (prespecified primary endpoint) were 53Á6% (n = 82) in the PCI group and 33Á8% (n = 27) in the OMT group (P = 0Á004). Analysis of the individual medication classes revealed similar results for beta-blockers (86Á0% in PCI group vs. 72Á5% in OMT group, P = 0Á006) and statins (64Á5% in PCI group vs. 44Á0% in OMT group, P = 0Á003). Adherence to ACEI was also higher in the PCI group, but the difference was not statistically significant (77Á6% vs. 69Á3%, P = 0Á17). By logistic regression analysis, belonging to the PCI group was an independent predictor of medication adherence [B = 2Á20 (1Á06–4Á50), P = 0Á03)]. What is new and conclusion: In the present study we demon- strated that adherence to evidence-based medication therapies in patients treated with PCI is significantly higher than in patients treated with OMT alone. Medication adherence should be followed carefully in CAD patients treated with OMT. INTRODUCTION Medications that improve survival in patients with coronary artery disease (CAD) include antiplatelet agents, beta-blockers, angioten- sin-converting enzyme inhibitors (ACEIs) and lipid-lowering therapy, particularly statins, in appropriate patients. The routine use of these agents is recommended for secondary prevention among patients with documented CAD. 1 Randomized controlled trials, such as the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation Trial (COURAGE), have been carried out to compare the outcomes of percutaneous coronary intervention (PCI) combined with optimal medical therapy (OMT) vs. OMT alone, in patients with stable CAD. 2 Although medication adherence is not a variable in such trials, where it is guaranteed through strict follow-ups by trained nurse managers, 3–6 in real life, medication adherence is often poor. 7–12 Several studies have shown that medication adherence strongly affects outcomes over a broad spectrum of CAD. 13,14 Although many studies have examined medication adherence in patients with CAD, there has been no prospective trial comparing the medication adherence between patients treated with PCI and OMT. 15 The purpose of this study was to investigate the adherence to evidence-based medication therapies in documented patients with CAD under real-life conditions and to make a comparison between PCI combined with OMT and OMT alone. METHODS Patient population Patients undergoing cardiac catheterization at the Cardiology Institute of Istanbul University (Istanbul) were screened for study enrolment from July 2011 through July 2012. Patients with stable CAD who were hospitalized for cardiac catheterization were eligible if they had documented CAD (presence of ≥50% coronary occlusion on cardiac catheterization), treated with either OMT or PCI and were prescribed ACEI, beta-blockers and statins accord- ing to current guidelines. 16,17 We did not assess the use of aspirin, because it can be obtained without a prescription; therefore, adherence to this agent could not be determined from prescription records. Patients were required to have their prescription medica- tions filled by any one of the pharmacies supplying medications for national health insurance reimbursement for 6 months after hospital discharge. The exclusion criteria for the study were as follows: hospital stay shorter than needed for enrolment, inability to provide informed consent (cognitive impairment or altered mental status), scheduled for coronary artery bypass graft surgery (CABG), terminal condition with low likelihood of 6-month survival and prior CABG or prior PCI. Adherence to follow-up medication All patients in both study arms were evaluated at the first-, third- and sixth-month visits. The primary endpoint was the percentage Correspondence: C. Kocas, MD, Cardiologist, Instructor, Department of Cardiology, Istanbul University Institute of Cardiology, Haseki, Aksaray 34350, Istanbul, Turkey. Tel.: 90 505 938 3527; fax: 90 212 450 2069; e-mail: cuneytkocas@hotmail.com © 2013 John Wiley & Sons Ltd 476 Journal of Clinical Pharmacy and Therapeutics, 2013, 38, 476–479 doi: 10.1111/jcpt.12091