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.
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), diabeticpatients 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.
Authors: Elizabeth A Chrischilles; Kathleen M Schneider; Mary C Schroeder; Elena Letuchy; Robert B Wallace; Jennifer G Robinson; John M Brooks Journal: J Am Geriatr Soc Date: 2016-03-01 Impact factor: 5.562
Authors: Charles D Resor; Ashwin Nathan; Dean J Kereiakes; Robert W Yeh; Joseph M Massaro; Donald E Cutlip; P Gabriel Steg; Wen-Hua Hsieh; Laura Mauri Journal: Circulation Date: 2016-08-30 Impact factor: 29.690
Authors: Massimo F Piepoli; Arno W Hoes; Stefan Agewall; Christian Albus; Carlos Brotons; Alberico L Catapano; Marie-Therese Cooney; Ugo Corrà; Bernard Cosyns; Christi Deaton; Ian Graham; Michael Stephen Hall; F D Richard Hobbs; Maja-Lisa Løchen; Herbert Löllgen; Pedro Marques-Vidal; Joep Perk; Eva Prescott; Josep Redon; Dimitrios J Richter; Naveed Sattar; Yvo Smulders; Monica Tiberi; H Bart van der Worp; Ineke van Dis; W M Monique Verschuren; Simone Binno Journal: Eur Heart J Date: 2016-05-23 Impact factor: 29.983
Authors: Joep Perk; Guy De Backer; Helmut Gohlke; Ian Graham; Zeljko Reiner; W M Monique Verschuren; Christian Albus; Pascale Benlian; Gudrun Boysen; Renata Cifkova; Christi Deaton; Shah Ebrahim; Miles Fisher; Giuseppe Germano; Richard Hobbs; Arno Hoes; Sehnaz Karadeniz; Alessandro Mezzani; Eva Prescott; Lars Ryden; Martin Scherer; Mikko Syvänne; Wilma J M Scholte Op Reimer; Christiaan Vrints; David Wood; Jose Luis Zamorano; Faiez Zannad Journal: Int J Behav Med Date: 2012-12