The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction
Objectives Five drug classes have been shown to improve the prognosis of acute myocardial infarction in clinical trials: aspirin, β-blockers, statins, renin angiotensin system (RAS) blockers and thienopyridines. We aimed to assess whether the benefits of combining these drugs (termed optimal medical...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article (Journal) |
| Language: | English |
| Published: |
March 31, 2010
|
| In: |
Heart
Year: 2010, Volume: 96, Issue: 8, Pages: 604-609 |
| ISSN: | 1468-201X |
| DOI: | 10.1136/hrt.2009.188607 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/hrt.2009.188607 Verlag, lizenzpflichtig, Volltext: https://heart.bmj.com/content/96/8/604 
|
| Author Notes: | P Bramlage, C Messer, N Bitterlich, C Pohlmann, A Cuneo, E Stammwitz, J Tebbenjohanns, H Gohlke, J Senges, U Tebbe |
| Summary: | Objectives Five drug classes have been shown to improve the prognosis of acute myocardial infarction in clinical trials: aspirin, β-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% β-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 β-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. |
|---|---|
| Item Description: | Gesehen am 15.02.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1468-201X |
| DOI: | 10.1136/hrt.2009.188607 |