title: Long-term medication adherence in patients with ST-elevation myocardial infarction and primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Besides early percutaneous coronary intervention (PCI) long-term medical treatment is crucial for outcomes after ST-elevation myocardial infarction (STEMI). The present study aimed to identify predictors of adherence to evidence-based medication in this high risk population.
  
  
  RESULTS
  A total of 1025 consecutive patients with adjudicated STEMI treated by primary PCI in a single centre as part of the Cologne Infarction Model (KIM) were prospectively analysed. Gender-specific multivariate predictors of long-term medication adherence were identified. Follow-up with available information on drug use was completed for 610 of 738 (82.7%) patients confirmed to be alive after a median period of 36 months. Adherence was persistently high for evidence-based medication with 90.8% for acetylsalicylic acid (ASA), 88.2% for statins, 87.5% for beta-blockers and 79.2% for ACE-inhibitors or angiotensin-receptor blockers (ARBs). Patients with a history of heart failure had a higher medication adherence to beta-blockers, ACE-inhibitors/ARBs and diuretics, whereas long-term prescription rates for calcium channel blockers (CCBs) were lower in patients with reduced versus preserved ejection fraction. Patients with a history of hypertension presented higher medication adherence to CCBs, ACE-inhibitors/ARBs and diuretics but not to beta-blockers. On multivariate analysis, age, body mass index (BMI), hypertension, chronic kidney disease and lack of PCI were independently associated with prescription of diuretics at follow-up. In women, adherence was lower to beta-blockers and higher to CCBs compared to men.
  
  
  CONCLUSIONS
  In the high risk population of STEMI patients long-term adherence to evidence-based medication is high. The lower adherence to beta-blockers and higher prescription rate for CCBs in women needs particular attention.
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany hannes.reuter@uk-koeln.de.
authors.forename: Hannes
authors.initials: H
authors.lastname: Reuter
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Markhof
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Scholz
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wegmann
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Catherine
authors.initials: C
authors.lastname: Seck
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Adler
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Michels
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Hans-Wilhelm
authors.initials: HW
authors.lastname: Hoepp
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.affiliation: Department of Internal Medicine III, Heart Centre of the University of Cologne, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Pfister
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D011307:Drug Prescriptions; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: ST-elevation myocardial infarction; gender; medication adherence; secondary prevention