Effect of use of combination evidence-based medical therapy after acute coronary syndromes on long-term outcomes.
Several medications have individually been shown to reduce mortality in patients with acute coronary syndromes (ACS), but data on long-term outcomes related to the use of combinations of these medications are limited. For 2,684 consecutive patients admitted with ACS from January 1999 and January 2007, a composite score was calculated correlating with the use upon discharge of indicated evidence-based medications (EBMs): aspirin, β blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and lipid-lowering agents. Multivariate models were used to examine the impact of EBM score on 2-year events with adjustment for components of the Global Registry of Acute Coronary Events (GRACE) risk score, thienopyridine use, and year of discharge. Women were older, had more co-morbidities, and were less likely to receive all 4 EBMs (53% vs 64%, p < 0.0001) than men. Patients who received all 4 indicated EBMs had a significant 2-year survival benefit compared to patients who received ≤1 EBM (odds ratio 0.25, 95% confidence interval 0.15 to 0.41), which was observed when men and women were examined separately (for men, odds ratio 0.22, 95% confidence interval 0.11 to 0.44; for women, odds ratio 0.3, 95% confidence interval 0.15 to 0.63). A modest benefit, in terms of cardiovascular disease events (myocardial infarction, rehospitalization, stroke, and death), was observed only for men who received all 4 EBMs. In conclusion, a combination of cardiac medications at the time of ACS discharge is strongly associated with 2-year survival in men and women, suggesting that discharge is an important time to prescribe secondary preventative medications.
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, USA.
Rony
R
Lahoud
Michael
M
Howe
Sangeetha M
SM
Krishnan
Sibin
S
Zacharias
Elizabeth A
EA
Jackson
D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D016001:Confidence Intervals; D004562:Electrocardiography; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome