The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction
| Autor: | J. Tebbenjohanns, Jochen Senges, Christiane Pohlmann, N Bitterlich, E. Stammwitz, Ulrich Tebbe, Peter Bramlage, Alessandro Cuneo, C. Messer, H. Gohlke |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Thienopyridine Myocardial Infarction Pharmacotherapy Internal medicine Epidemiology medicine Humans Myocardial infarction Prospective Studies Prospective cohort study Aged Aspirin business.industry Cardiovascular Agents Middle Aged medicine.disease Clopidogrel Clinical trial Hospitalization Cardiology Drug Therapy Combination Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Heart (British Cardiac Society). 96(8) |
| ISSN: | 1468-201X |
| Popis: | Objectives Five drug classes have been shown to improve the prognosis of acute myocardial infarction in clinical trials: aspirin, b-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% b-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 2e4 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 b-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. |
| Databáze: | OpenAIRE |
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