The impact of age and chronic kidney disease on secondary prevention post-primary percutaneous coronary intervention.

Design: We studied 1169 consecutive patients from five UK centres receiving PPCI for ST elevation MI, with use of evidence-based secondary prevention at discharge assessed by age (< 60, 60-75 and > 75 years) and estimated glomerular filtration rate (eGFR). Follow-up prescribing practice was assessed in 567 patients. Results: One-fifth of patients receiving PPCI were > 75 years. This group received fewer secondary prevention drugs at discharge compared to younger patients (P < 0.01 for beta-blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and statins). By 6 weeks post-PPCI, there was a small drop-off in evidence-based therapy; beta-blocker and statin use in those > 75 years fell from 90% to 86% and 96% to 93%, respectively. CKD (eGFR < 60 ml/min/1.73 m(2)) was seen in 17.6%. Declining renal function was associated with age, female sex and lower use of ACE inhibitor/ARB. At discharge 83.5% of patients with eGFR < 60 ml/min/1.73 m(2) were receiving ACE inhibitors/ARB, dropping to 77.5% at 6 weeks (compared with 95% and 92%, respectively, in patients with eGFR > 60 ml/min/1.73 m(2)). Conclusions: The uptake of secondary prevention medication is high following PPCI in the UK, even in the elderly and in those with renal dysfunction. A focus on strategies to improve up-titration and continuation of drugs following discharge is required.