title: Optimal secondary prevention medication use in acute myocardial infarction patients with nonobstructive coronary artery disease is modified by management strategy: insights from the TRIUMPH Registry.
abstract: BACKGROUND
  Patients with acute myocardial infarction (AMI) and nonobstructive coronary artery disease (nonobCAD) may be perceived to be at lower risk for cardiac events, relative to those with obstructive CAD (obCAD), and thus less likely to receive optimal preventive medications in the year following AMI.
  
  
  OBJECTIVE
  We aimed to determine if AMI patients with nonobCAD, compared to obCAD, received lower rates of prevention medications in the year following AMI.
  
  
  METHODS
  We compared optimal prevention medication use at hospital discharge, 1, 6, and 12 months after hospitalization. Optimal medication use was defined as the receipt of all prevention medications for which that patient was eligible (eg, aspirin, clopidogrel, statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers). We used multivariable logistic regression analyses to determine the association between nonobCAD to medication use and adjusted for potential confounders.
  
  
  RESULTS
  Three thousand six hundred thirty AMI patients were studied, of whom 200 (5.2%) had nonobCAD. Fewer nonobCAD patients received optimal medication use compared to obCAD patients at discharge (31% vs 65%, P < 0.001), driven primarily by lower rates of clopidogrel use (40.5% vs 83.3%, P < 0.001). After adjustment for percutaneous coronary intervention (PCI), differences in medication use were similar at discharge and 1 year after hospitalization. Stratified analyses by receipt of PCI suggested patients confined to medical management had less optimal medication use, regardless of their CAD burden.
  
  
  CONCLUSIONS
  Lower rates of unadjusted optimal medication use were seen in nonobCAD patients, driven by low clopidogrel use among medically managed patients, suggesting improvement efforts should focus on these patients.
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Reynaria
authors.initials: R
authors.lastname: Pitts
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.|Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.
authors.forename: Stacie L
authors.initials: SL
authors.lastname: Daugherty
authors.affiliation: Saint Luke's/Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Kansas.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: Saint Luke's/Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Kansas.
authors.forename: Philip
authors.initials: P
authors.lastname: Jones
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.|VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.|Institute for Health Research, Kaiser Permanente, Denver, Colorado.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: Saint Luke's/Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Kansas.
authors.forename: John
authors.initials: J
authors.lastname: Spertus
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.|VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Thomas M
authors.identifier: http://orcid.org/0000-0002-7364-1728
authors.initials: TM
authors.lastname: Maddox
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors; D017410:Practice Guidelines as Topic; D012042:Registries; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Anti platelet therapy; Clopidogrel; Non-obstructive CAD; Preventive cardiology; myocardial infarction < Ischemic heart disease