Evidence-Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention

Kyusup Lee, Seungbong Han, Myunhee Lee, Dae Won Kim, Jongbum Kwon, Gyung Min Park, Mahn Won Park

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

BACKGROUND: The secondary prevention with pharmacologic therapy is essential for preventing recurrent cardiovascular events in patients experiencing acute myocardial infarction. Guideline-based optimal medical therapy (OMT) for patients with acute myocardial infarction consists of antiplatelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, β-blockers, and statins. We aimed to determine the prescription rate of OMT use at discharge and to evaluate the impact of OMT on long-term clinical outcomes in patients with acute myocardial infarction who underwent percutaneous coronary intervention in the drug-eluting stent era using nationwide cohort data. METHODS AND RESULTS: Using the National Health Insurance claims data in South Korea, patients with acute myocardial infarction who had undergone percutaneous coronary intervention with a drug-eluting stent between July 2013 and June 2017 were enrolled. A total of 35 972 patients were classified into the OMT and non-OMT groups according to the post-percutaneous coronary intervention discharge medication. The primary end point was all-cause death, and the 2 groups were compared using a propensity-score matching analysis. Fifty-seven percent of patients were prescribed OMT at discharge. During the follow-up period (median, 2.0 years [interquartile range, 1.1-3.2 years]), OMT was associated with a significant reduction in the all-cause mortality (adjusted hazard ratio [aHR], 0.82 [95% CI, 0.76-0.90]; P<0.001) and composite outcome of death or coronary revascularization (aHR, 0.89 [95% CI, 0.85-0.93]; P<0.001). CONCLUSIONS: OMT was prescribed at suboptimal rates in South Korea. However, our nationwide cohort study showed that OMT has a benefit for long-term clinical outcomes on all-cause mortality and composite outcome of death or coronary revascularization after percutaneous coronary intervention in the drug-eluting stent era.

Original languageEnglish
Article numbere024370
JournalJournal of the American Heart Association
Volume12
Issue number10
DOIs
StatePublished - 16 May 2023

Bibliographical note

Funding Information:
This work was supported in part by the National Research Foundation of Korea grant funded by the Korea government (number 2022R1F1A1063027) and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (number HI22C045400).

Publisher Copyright:
© 2023, American Heart Association Inc.. All rights reserved.

Keywords

  • acute myocardial infarction
  • drug-eluting stent
  • optimal medical therapy
  • outcome

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