BACKGROUND: Several classes of medications improve survival in patients with coronary artery disease. Whether these medications, as used in the real world, have additive efficacy remains speculative. OBJECTIVES: To assess whether patients discharged on combined secondary prevention medications after acute myocardial infarction (AMI) have improved 1-year survival, compared with the action of any single class of medications. DESIGN AND SETTING: Nationwide registry of consecutive patients admitted to intensive care units for AMI in November 2000 in France. Multivariate Cox regression analysis, including a propensity score for the prescription of combined therapy, was used. RESULTS: Of the 2119 patients discharged alive, 1095 (52%) were prescribed a combination of antiplatelet agents, beta-blockers, and statins (triple therapy), of whom 567 (27%) also received angiotensin-converting enzyme inhibitors (quadruple therapy) and 528 (25%) did not. One-year survival was 97% in patients receiving triple combination therapy versus 88% in those who received either none, 1, or 2 of these medications (P < .0001). After multivariate adjustment including the propensity score, the hazard ratio for 1-year mortality in patients with triple combination therapy was 0.52 (95% CI 0.33-0.81). In patients with ejection fraction < or = 35%, beta-blockers and angiotensin-converting enzyme inhibitors were independent predictors of survival, and combination therapy had no additional prognostic value. CONCLUSIONS: Compared with the prescription of any single class of secondary prevention medications, combination therapy offers additional protection in patients with AMI.
BACKGROUND: Several classes of medications improve survival in patients with coronary artery disease. Whether these medications, as used in the real world, have additive efficacy remains speculative. OBJECTIVES: To assess whether patients discharged on combined secondary prevention medications after acute myocardial infarction (AMI) have improved 1-year survival, compared with the action of any single class of medications. DESIGN AND SETTING: Nationwide registry of consecutive patients admitted to intensive care units for AMI in November 2000 in France. Multivariate Cox regression analysis, including a propensity score for the prescription of combined therapy, was used. RESULTS: Of the 2119 patients discharged alive, 1095 (52%) were prescribed a combination of antiplatelet agents, beta-blockers, and statins (triple therapy), of whom 567 (27%) also received angiotensin-converting enzyme inhibitors (quadruple therapy) and 528 (25%) did not. One-year survival was 97% in patients receiving triple combination therapy versus 88% in those who received either none, 1, or 2 of these medications (P < .0001). After multivariate adjustment including the propensity score, the hazard ratio for 1-year mortality in patients with triple combination therapy was 0.52 (95% CI 0.33-0.81). In patients with ejection fraction < or = 35%, beta-blockers and angiotensin-converting enzyme inhibitors were independent predictors of survival, and combination therapy had no additional prognostic value. CONCLUSIONS: Compared with the prescription of any single class of secondary prevention medications, combination therapy offers additional protection in patients with AMI.
Authors: J Bezin; A Pariente; R Lassalle; C Dureau-Pournin; A Abouelfath; P Robinson; N Moore; C Droz-Perroteau; A Fourrier-Reglat Journal: Eur J Clin Pharmacol Date: 2013-11-24 Impact factor: 2.953
Authors: Zoltán Vokó; Sophie de Brouwer; Jacobus Lubsen; Nicolas Danchin; Jan-Erik Otterstad; Peter H J M Dunselman; Bridget-Anne Kirwan Journal: Eur J Epidemiol Date: 2011-02-19 Impact factor: 8.082
Authors: Valérie Bourdès; Jean Ferrières; Jacques Amar; Elisabeth Amelineau; Stéphane Bonnevay; Maryse Berlion; Nicolas Danchin Journal: Med Biol Eng Comput Date: 2011-05-20 Impact factor: 2.602