title: Estimating mortality in survivors of the acute coronary syndrome by the 4-drug score.
abstract: OBJECTIVE
  Four drug classes, platelet inhibitors, β-blockers, statins, and angiotensin-converting enzyme inhibitors (or angiotensin receptor blockers), have been shown to reduce mortality in clinical trials. We sought to evaluate whether the simple number of secondary prevention drugs at discharge is independently associated with 1-year mortality in acute coronary syndrome (ACS) patients.
  
  
  METHODS
  We analyzed a prospective cohort study using data of all 5 Acute Coronary Syndrome Israeli Surveys (ACSIS) conducted between 2002 and 2010 in all Israeli cardiology departments. All 9,107 hospital survivors of ACS participated.
  
  
  RESULTS
  A score from 1 to 4 discharge drugs was significantly associated with gradual decreasing rates of 1-year mortality (14.4, 9.0, 5.1, and 3.6%, respectively; p for trend <0.001). Only when the number of discharge drugs increased to 3-4 as a result of the intervention during hospitalization in patients initially admitted with 0-2 drugs, a significant multivariate-adjusted decrease in the hazard ratio (HR), independent of multiple baseline, admission presentation, and in-hospital course characteristics, was measured (HR, 0.66; 95% confidence interval, 0.50-0.87).
  
  
  CONCLUSIONS
  The use of a higher number of secondary prevention drugs at discharge following ACS was associated with significantly lower mortality rates, particularly in patients with mono- or dual-baseline therapy.
authors.affiliation: Neufeld Cardiac Research Institute, Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Kopel
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Ehud
authors.initials: E
authors.lastname: Schwammenthal
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000517:prevention & control; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D017741:Survivors / Q000706:statistics & numerical data
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors