The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction.
OBJECTIVE
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.


METHODS
Nationwide registry


METHODS
Hospitals with a cardiology unit or internal medicine department.


METHODS
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.


METHODS
Pharmacotherapy


METHODS
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.
Bramlage
P
P
Klinikum Lippe GmbH, Fachbereich Herz-Kreislauf, Röntgenstrasse 18, 32756 Detmold, Germany. ulrich.tebbe@klinikum-lippe.de
Messer
C
C
Bitterlich
N
N
Pohlmann
C
C
Cuneo
A
A
Stammwitz
E
E
Tebbenjohanns
J
J
Gohlke
H
H
Senges
J
J
Tebbe
U
U
D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D011446:Prospective Studies
D002317:Cardiovascular Agents