title: Relation between combining evidence-based medications on mortality following myocardial infarction in patients with and without renal impairment.
abstract: BACKGROUND
  Antiplatelet agents, beta-blockers, statins and ACE inhibitors have been shown to reduce mortality in patients following myocardial infarction (MI). However, it is uncertain if the combination of these agents has a similar impact on mortality following MI in patients with renal dysfunction.
  
  
  METHODS
  We studied 5529 consecutive patients with confirmed MI between January 2000 and December 2003. Data on baseline demographics, co-morbidities and in-hospital management were collected prospectively. Glomerular filtration rate (GFR) was estimated using the 4-component Modification of Diet in Renal Disease equation. Based on discharge use of evidence-based medications, the patients were divided into those using 0, 1, 2, 3 or 4 medications. The impact of medication use on 1-year mortality was then assessed for patients with GFR > or =60 ml/min/1.73 m2 (group I) and GFR < 60 ml/min/1.73 m2 (group 2).
  
  
  RESULTS
  Mean age was 63 +/- 13 years with 71% men.The prevalence of reduced GFR was 35% and the adjusted odds ratio for I-year mortality of patients in group 2 compared to those in group I was 1.86 (95% CI 1.54-2.25, P < 0.001). Compared with patients with no medication, the adjusted odds ratio for 1-year mortality was lower in patients with 1, 2, 3 and 4 medications in both groups. There was no significant interaction between the number of medications used and GFR.
  
  
  CONCLUSIONS
  Increased use of combined evidence-based medications was independently associated with a lower 1-year post MI mortality. Such therapies offer similar survival benefit in patients with and without renal dysfunction.
authors.affiliation: Cardiac Department, National University Hospital, Singapore. edgartay1@gmail.com
authors.forename: Edgar Lik-Wui
authors.initials: EL
authors.lastname: Tay
authors.forename: Mark
authors.initials: M
authors.lastname: Chan
authors.forename: Virlynn
authors.initials: V
authors.lastname: Tan
authors.forename: Ling Ling
authors.initials: LL
authors.lastname: Sim
authors.forename: Huay Cheem
authors.initials: HC
authors.lastname: Tan
authors.forename: Yean Teng
authors.initials: YT
authors.lastname: Lim
authors.forename: Kheng-Thye
authors.initials: KT
authors.lastname: Ho
authors.forename: Boon-Lock
authors.initials: BL
authors.lastname: Chia
authors.forename: Poo Sing
authors.initials: PS
authors.lastname: Wong
authors.forename: Tiong Cheng
authors.initials: TC
authors.lastname: Yeo
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D009204:Myocardial Revascularization; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors