Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke
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Updated: Oct 14, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Dongfeng Zhang1, Xiantao Song2, Sergio Raposeiras-Roubín3
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Optimal medical therapy (OMT) significantly reduces mortality in acute myocardial infarction (AMI) patients with prior stroke. However, less than half of eligible patients receive OMT, indicating a need for improved treatment strategies.
Area of Science:
- Cardiology
- Neurology
- Clinical Medicine
Background:
- Acute myocardial infarction (AMI) patients with a history of stroke present a complex clinical challenge.
- The impact of optimal medical therapy (OMT) on outcomes in this population remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of OMT in reducing adverse events in AMI patients with prior stroke.
- To identify factors influencing OMT prescription and its association with clinical outcomes.
Main Methods:
- Retrospective analysis of 765 AMI patients with prior stroke from the BleeMACS registry who underwent percutaneous coronary intervention (PCI).
- Patients were categorized into OMT and non-OMT groups based on discharge medications.
- One-year follow-up for mortality, re-infarction, major adverse cardiovascular events (MACE), and bleeding.
Main Results:
- 47.7% of patients did not receive at least one OMT medication.
- OMT was associated with significantly lower 1-year mortality (4.5% vs. 15.1%), re-AMI (4.2% vs. 9.3%), and composite death/re-AMI (8.6% vs. 20.5%).
- OMT independently predicted reduced 1-year mortality, while advanced age was an independent risk factor. No significant difference in bleeding events was observed.
Conclusions:
- OMT at discharge is linked to substantially lower 1-year mortality in patients with AMI and prior stroke.
- A significant proportion of eligible patients do not receive OMT, highlighting a critical gap in care.
- Improving OMT prescription rates could lead to better clinical outcomes for this high-risk group.
Background:
Treatment of acute myocardial infarction (AMI) patients with prior stroke is a common clinical dilemma. Currently, the application of optimal medical therapy (OMT) and its impact on clinical outcomes are not clear in this patient population.
Methods:
We retrieved 765 AMI patients with prior stroke who underwent percutaneous coronary intervention (PCI) during the index hospitalization from the international multicenter BleeMACS registry. All of the subjects were divided into two groups based on the prescription they were given prior to discharge. Baseline characteristics and procedural variables were compared between the OMT and non-OMT groups. Mortality, re-AMI, major adverse cardiovascular events (MACE), and bleeding were followed-up for 1 year.
Results:
Approximately 5% of all patients presenting with AMI were admitted to the hospital for ischemic stroke. Although the prescription rate of each OMT medication was reasonably high (73.3%-97.3%), 47.7% lacked at least one OMT medication. Patients receiving OMT showed a significantly decreased occurrence of mortality (4.5% vs 15.1%, p < 0.001), re-AMI (4.2% vs 9.3%, p = 0.004), and the composite endpoint of death/re-AMI (8.6% vs 20.5%, p < 0.001) compared to those without OMT. No significant difference was observed between the groups regarding bleeding. After adjusting for confounding factors, OMT was the independent protective factor of 1-year mortality, while age was the independent risk factors.
Conclusions:
OMT at discharge was associated with a significantly lower 1-year mortality of patients with AMI and prior stroke in clinical practice. However, OMT was provided to just half of the eligible patients, leaving room for substantial improvement.
Clinical Trial Registration:
NCT02466854.
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