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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...

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Hauptverfasser: Bramlage, Peter (Verfasst von) , Messer, C. (Verfasst von) , Bitterlich, N. (Verfasst von) , Pohlmann, C. (Verfasst von) , Cuneo, A. (Verfasst von) , Stammwitz, E. (Verfasst von) , Tebbenjohanns, J. (Verfasst von) , Gohlke, H. (Verfasst von) , Senges, Jochen (Verfasst von) , Tebbe, U. (Verfasst von)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: March 31, 2010
In: Heart
Year: 2010, Jahrgang: 96, Heft: 8, Pages: 604-609
ISSN:1468-201X
DOI:10.1136/hrt.2009.188607
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/hrt.2009.188607
Verlag, lizenzpflichtig, Volltext: https://heart.bmj.com/content/96/8/604
Volltext
Verfasserangaben:P Bramlage, C Messer, N Bitterlich, C Pohlmann, A Cuneo, E Stammwitz, J Tebbenjohanns, H Gohlke, J Senges, U Tebbe
Beschreibung
Zusammenfassung: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.
Beschreibung:Gesehen am 15.02.2023
Beschreibung:Online Resource
ISSN:1468-201X
DOI:10.1136/hrt.2009.188607

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