The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction
- PMID: 20353936
- DOI: 10.1136/hrt.2009.188607
The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction
Abstract
Objectives: Five drug classes have been shown to improve the prognosis of acute myocardial infarction in clinical trials: aspirin, beta-blockers, statins, renin angiotensin system (RAS) blockers and thienopyridines. We aimed to assess whether the benefits of combining these drugs (termed optimal medical therapy, OMT), will result in a reduction of mortality in clinical practice.
Design: Nationwide registry
Setting: Hospitals with a cardiology unit or internal medicine department.
Patients: 5353 patients with acute myocardial infarction. At hospital discharge 89% received aspirin, 90% beta-blockers, 84% statins, 81% RAS blockers, 70% a thienopyridine and 46.2% OMT.
Interventions: Pharmacotherapy
Main outcome measures: OR with 95% CI for mortality from myocardial infarction were calculated and adjusted for patient risk at baseline.
Results: Total mortality was reduced by 74% in patients receiving OMT (adj OR 0.26; 95% CI 0.18 to 0.38) versus patients receiving one or no drug. This was consistent in subgroups defined by STEMI/NSTEMI, diabetes and gender. Mortality was also reduced in patients receiving 2-4 drugs (adj OR 0.49; 95% CI 0.35 to 0.68), diabetic patients being the only subgroup with no significant effect. Analyses on the relative importance of either component revealed that withdrawal of beta-blockers (adj OR 0.63; 95% CI 0.34 to 1.16) and/or a combination of aspirin/clopidogrel (adj OR 0.59; 95% CI 0.20 to 1.17) abolished the risk reduction conferred by OMT.
Conclusions: OMT over 1 year was associated with a significantly lower mortality of patients with acute myocardial infarction in clinical practice. However OMT is provided to less than half of eligible patients leaving room for substantial improvement.
Comment in
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Comments on an acute myocardial infarction study.Heart. 2010 Nov;96(21):1780. doi: 10.1136/hrt.2010.205674. Epub 2010 Aug 11. Heart. 2010. PMID: 20702539 No abstract available.
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