Trends in optimal medical therapy prescription and mortality after admission for acute coronary syndrome: a 9-year experience in a real-world setting

Niels P. G. Hoedemaker, Peter Damman, Jan Paul Ottervanger, Jan Henk E. Dambrink, A. T. Marcel Gosselink, Elvin Kedhi, Evelien Kolkman, Robbert J. de Winter, ArnoudW. J. van 't Hof*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Web of Science)

Abstract

Aims Optimal medical therapy (OMT) is recommended in acute coronary syndrome (ACS) patients. Few studies present temporal trends of OMT prescription and its impact on outcomes in a real-world setting. We aimed to evaluate OMT prescription in a real-world ACS population and its relation to mortality during almost a decade . Methods and results Consecutive ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (NSTEMI) patients (n = 9202) admitted to a single Dutch tertiary hospital between 2006 and 2014 were included and followed for drug prescription and mortality up to 1 year. Optimal medical therapy was defined as prescription of aspirin, P2Y12inhibitors, statin, beta-blockers, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARB). Optimal medical therapy prescription was 43.7% at discharge, 46.6% at 30-days, and 25.5% at 1-year. Optimal medical therapy prescription at discharge was lower among NSTEMI patients (34.5% vs. 49.2%, P < 0.001). Optimal medical therapy prescription at discharge, 30-days and 1-year and mortality outcomes did not change during the study period. After adjustment for baseline and admission characteristics, OMT at discharge was associated with a reduction in mortality in patients who survived hospitalization for the index event [adjusted hazard ratio: 0.66, 95% confidence interval (0.46-0.93)]. Conclusions In this single-centre observational registry with > 9000 patients reflecting almost a decade of ACS care, < 50% of patients were on OMT at discharge. Prescription of OMT and mortality outcomes remained stable during the study period. After adjustment, OMT prescription at discharge was associated with reduced mortality in ACS survivors. Further contemporary randomized studies are warranted to determine the role of beta-blockers and ACEi/ARBs in ACS patients with preserved left ventricular ejection fraction.
Original languageEnglish
Pages (from-to)102-110
Number of pages9
JournalEuropean Heart Journal-Cardiovascular Pharmacotherapy
Volume4
Issue number2
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • Registry
  • Acute coronary syndrome
  • Outcomes
  • Optimal medical therapy
  • ACUTE MYOCARDIAL-INFARCTION
  • ST-SEGMENT-ELEVATION
  • SECONDARY PREVENTION
  • GUIDELINE ADHERENCE
  • EUROPEAN-SOCIETY
  • HEART-FAILURE
  • TASK-FORCE
  • OUTCOMES
  • DISEASE
  • DYSFUNCTION

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