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Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis
BACKGROUND: Survivors of myocardial infarction have an elevated risk of long-term mortality. We sought to evaluate guideline-directed medical treatment and its impact on long-term mortality in survivors of ST-elevation myocardial infarction (STEMI) according to their chronic kidney disease (CKD) sta...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10616503/ https://www.ncbi.nlm.nih.gov/pubmed/37915929 http://dx.doi.org/10.1093/ckj/sfad219 |
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author | Engelbertz, Christiane Feld, Jannik Makowski, Lena Lange, Stefan A Günster, Christian Dröge, Patrik Ruhnke, Thomas Gerß, Joachim Reinecke, Holger Köppe, Jeanette |
author_facet | Engelbertz, Christiane Feld, Jannik Makowski, Lena Lange, Stefan A Günster, Christian Dröge, Patrik Ruhnke, Thomas Gerß, Joachim Reinecke, Holger Köppe, Jeanette |
author_sort | Engelbertz, Christiane |
collection | PubMed |
description | BACKGROUND: Survivors of myocardial infarction have an elevated risk of long-term mortality. We sought to evaluate guideline-directed medical treatment and its impact on long-term mortality in survivors of ST-elevation myocardial infarction (STEMI) according to their chronic kidney disease (CKD) stage. METHODS: Using German health insurance claims data, 157 663 hospitalized survivors of STEMI were identified. Regarding different CKD stages, we retrospectively analysed the filled prescriptions of platelet inhibitors (PAI)/oral anticoagulation, statins, beta-blocker and angiotensin-converting enzyme inhibitors/angiotensin II type 1 receptor antagonists (ACE-I/AT1-A) and their association with long-term mortality. RESULTS: Prescription rates for all four guideline-directed drugs were highest in patients without or with mild CKD and lowest in patients on dialysis. They dropped from 73.4% to 39.2% in patients without CKD and from 47.1% to 29% in patients on dialysis within the 5-year follow-up period. Mortality rates were dramatically increased in patients with CKD compared with patients without CKD (5-year mortality: no CKD, 16.7%; CKD stage 3, 47.1%; CKD stage 5d, 69.7%). Filled prescriptions of at least one drug class [one drug: hazard ratio (HR) 0.70, 95% confidence interval (95% CI) 0.66–0.74; four drugs: HR 0.28, 95% CI 0.27–0.30; P < .001 for both] as well as the distinct drug classes (statins: HR 0.55, 95% CI 0.54–0.56; ACE-I/AT1-A: HR 0.68, 95% CI 0.67–0.70; beta-blocker: HR 0.87, 95% CI 0.85–0.90; PAI/oral anticoagulation: HR 0.97, 95% CI 0.95–1.00; all P < .05) improved long-term mortality. CONCLUSIONS: An improved long-term guideline-recommended drug therapy after STEMI regardless of renal impairment might lead to beneficial effects on long-term mortality. |
format | Online Article Text |
id | pubmed-10616503 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106165032023-11-01 Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis Engelbertz, Christiane Feld, Jannik Makowski, Lena Lange, Stefan A Günster, Christian Dröge, Patrik Ruhnke, Thomas Gerß, Joachim Reinecke, Holger Köppe, Jeanette Clin Kidney J Original Article BACKGROUND: Survivors of myocardial infarction have an elevated risk of long-term mortality. We sought to evaluate guideline-directed medical treatment and its impact on long-term mortality in survivors of ST-elevation myocardial infarction (STEMI) according to their chronic kidney disease (CKD) stage. METHODS: Using German health insurance claims data, 157 663 hospitalized survivors of STEMI were identified. Regarding different CKD stages, we retrospectively analysed the filled prescriptions of platelet inhibitors (PAI)/oral anticoagulation, statins, beta-blocker and angiotensin-converting enzyme inhibitors/angiotensin II type 1 receptor antagonists (ACE-I/AT1-A) and their association with long-term mortality. RESULTS: Prescription rates for all four guideline-directed drugs were highest in patients without or with mild CKD and lowest in patients on dialysis. They dropped from 73.4% to 39.2% in patients without CKD and from 47.1% to 29% in patients on dialysis within the 5-year follow-up period. Mortality rates were dramatically increased in patients with CKD compared with patients without CKD (5-year mortality: no CKD, 16.7%; CKD stage 3, 47.1%; CKD stage 5d, 69.7%). Filled prescriptions of at least one drug class [one drug: hazard ratio (HR) 0.70, 95% confidence interval (95% CI) 0.66–0.74; four drugs: HR 0.28, 95% CI 0.27–0.30; P < .001 for both] as well as the distinct drug classes (statins: HR 0.55, 95% CI 0.54–0.56; ACE-I/AT1-A: HR 0.68, 95% CI 0.67–0.70; beta-blocker: HR 0.87, 95% CI 0.85–0.90; PAI/oral anticoagulation: HR 0.97, 95% CI 0.95–1.00; all P < .05) improved long-term mortality. CONCLUSIONS: An improved long-term guideline-recommended drug therapy after STEMI regardless of renal impairment might lead to beneficial effects on long-term mortality. Oxford University Press 2023-09-04 /pmc/articles/PMC10616503/ /pubmed/37915929 http://dx.doi.org/10.1093/ckj/sfad219 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Engelbertz, Christiane Feld, Jannik Makowski, Lena Lange, Stefan A Günster, Christian Dröge, Patrik Ruhnke, Thomas Gerß, Joachim Reinecke, Holger Köppe, Jeanette Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis |
title | Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis |
title_full | Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis |
title_fullStr | Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis |
title_full_unstemmed | Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis |
title_short | Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis |
title_sort | contemporary secondary prevention in survivors of st-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10616503/ https://www.ncbi.nlm.nih.gov/pubmed/37915929 http://dx.doi.org/10.1093/ckj/sfad219 |
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