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

Kyusup Lee1,2, Seungbong Han3, Myunhee Lee1,2

  • 1Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea.

Journal of the American Heart Association
|May 9, 2023
PubMed

Insights

Optimal medical therapy (OMT) reduces mortality in acute myocardial infarction patients post-percutaneous coronary intervention. Despite suboptimal prescription rates, OMT significantly lowers long-term all-cause death and revascularization events.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Secondary prevention is crucial for patients with acute myocardial infarction (AMI) to prevent recurrent cardiovascular events.
  • Guideline-based optimal medical therapy (OMT) includes antiplatelet therapy, ACE inhibitors/ARBs, beta-blockers, and statins.
  • The study focuses on the drug-eluting stent era for percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To determine the prescription rate of OMT at discharge for AMI patients undergoing PCI.
  • To evaluate the long-term clinical outcomes associated with OMT in this patient population.
  • To analyze nationwide cohort data from South Korea.

Main Methods:

  • Utilized National Health Insurance claims data from South Korea (July 2013 - June 2017).
  • Included 35,972 patients with AMI who underwent PCI with drug-eluting stents.
  • Employed propensity-score matching to compare OMT and non-OMT groups, with all-cause death as the primary endpoint.

Main Results:

  • OMT was prescribed at discharge in 57% of patients.
  • During a median 2.0-year follow-up, OMT significantly reduced all-cause mortality (aHR, 0.82; P<0.001).
  • OMT also decreased the composite outcome of death or coronary revascularization (aHR, 0.89; P<0.001).

Conclusions:

  • OMT prescription rates at discharge were suboptimal in South Korea.
  • This nationwide study demonstrates the long-term benefits of OMT in reducing mortality and revascularization events after PCI in the drug-eluting stent era.
  • OMT is associated with improved clinical outcomes for AMI patients.

Keywords:
acute myocardial infarctiondrug‐eluting stentoptimal medical therapyoutcome

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