Cargando…

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

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 thera...

Descripción completa

Detalles Bibliográficos
Autores principales: Lee, Kyusup, Han, Seungbong, Lee, Myunhee, Kim, Dae‐Won, Kwon, Jongbum, Park, Gyung‐Min, Park, Mahn‐Won
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227320/
https://www.ncbi.nlm.nih.gov/pubmed/37158100
http://dx.doi.org/10.1161/JAHA.121.024370
_version_ 1785050745290096640
author Lee, Kyusup
Han, Seungbong
Lee, Myunhee
Kim, Dae‐Won
Kwon, Jongbum
Park, Gyung‐Min
Park, Mahn‐Won
author_facet Lee, Kyusup
Han, Seungbong
Lee, Myunhee
Kim, Dae‐Won
Kwon, Jongbum
Park, Gyung‐Min
Park, Mahn‐Won
author_sort Lee, Kyusup
collection PubMed
description 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.
format Online
Article
Text
id pubmed-10227320
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-102273202023-05-31 Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention Lee, Kyusup Han, Seungbong Lee, Myunhee Kim, Dae‐Won Kwon, Jongbum Park, Gyung‐Min Park, Mahn‐Won J Am Heart Assoc Original Research 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. John Wiley and Sons Inc. 2023-05-09 /pmc/articles/PMC10227320/ /pubmed/37158100 http://dx.doi.org/10.1161/JAHA.121.024370 Text en © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Lee, Kyusup
Han, Seungbong
Lee, Myunhee
Kim, Dae‐Won
Kwon, Jongbum
Park, Gyung‐Min
Park, Mahn‐Won
Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention
title Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention
title_full Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention
title_fullStr Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention
title_full_unstemmed Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention
title_short Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention
title_sort evidence‐based optimal medical therapy and mortality in patients with acute myocardial infarction after percutaneous coronary intervention
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227320/
https://www.ncbi.nlm.nih.gov/pubmed/37158100
http://dx.doi.org/10.1161/JAHA.121.024370
work_keys_str_mv AT leekyusup evidencebasedoptimalmedicaltherapyandmortalityinpatientswithacutemyocardialinfarctionafterpercutaneouscoronaryintervention
AT hanseungbong evidencebasedoptimalmedicaltherapyandmortalityinpatientswithacutemyocardialinfarctionafterpercutaneouscoronaryintervention
AT leemyunhee evidencebasedoptimalmedicaltherapyandmortalityinpatientswithacutemyocardialinfarctionafterpercutaneouscoronaryintervention
AT kimdaewon evidencebasedoptimalmedicaltherapyandmortalityinpatientswithacutemyocardialinfarctionafterpercutaneouscoronaryintervention
AT kwonjongbum evidencebasedoptimalmedicaltherapyandmortalityinpatientswithacutemyocardialinfarctionafterpercutaneouscoronaryintervention
AT parkgyungmin evidencebasedoptimalmedicaltherapyandmortalityinpatientswithacutemyocardialinfarctionafterpercutaneouscoronaryintervention
AT parkmahnwon evidencebasedoptimalmedicaltherapyandmortalityinpatientswithacutemyocardialinfarctionafterpercutaneouscoronaryintervention