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Use of Guideline-Directed Medical Therapy in Patients With ST-Elevation Myocardial Infarction

Introduction ST-elevation myocardial infarction (STEMI) is a serious manifestation of coronary artery disease and remains a significant contributor to morbidity and mortality worldwide. To reduce the risk of recurrent cardiovascular disease (CVD) events, the American College of Cardiology (ACC) and...

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Autores principales: Latifi, Ahmad Nawid, Akram, Abeera, Dengle, Samir, Minhas, Amjad, Borz-Baba, Carolina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449638/
https://www.ncbi.nlm.nih.gov/pubmed/32864229
http://dx.doi.org/10.7759/cureus.9398
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author Latifi, Ahmad Nawid
Akram, Abeera
Dengle, Samir
Minhas, Amjad
Borz-Baba, Carolina
author_facet Latifi, Ahmad Nawid
Akram, Abeera
Dengle, Samir
Minhas, Amjad
Borz-Baba, Carolina
author_sort Latifi, Ahmad Nawid
collection PubMed
description Introduction ST-elevation myocardial infarction (STEMI) is a serious manifestation of coronary artery disease and remains a significant contributor to morbidity and mortality worldwide. To reduce the risk of recurrent cardiovascular disease (CVD) events, the American College of Cardiology (ACC) and American Heart Association (AHA) recommend the use of five classes of medications after acute coronary syndrome (ACS). The purpose of this study was to evaluate whether STEMI patients admitted to our community hospital were discharged on optimal medical therapy based on the latest AHA/ACC guidelines. Methods A retrospective, single-center electronic medical records review was conducted at our community hospital between July 2017 and December 2018. Patients included in the study were admitted to our hospital through the emergency department as STEMI alerts. We reviewed the discharge prescriptions and assessed compliance with the medication regimen endorsed by AHA/ACC, which includes aspirin, P2Y12 inhibitors, β-blockers, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and statins. Results A total of 147 patients were included in our study. The mean age of our study population was 62 ± 12.48 years. 97.2% of all patients with STEMI underwent coronary angiography. Hypertension (65.9%) was the most common comorbidity followed by hyperlipidemia (54.42%), diabetes mellitus (29.25%), and history of coronary artery disease (CAD) (24.48%). Among patients with successful reperfusion, 87.4% of the patients received the combination of four guideline-directed medical therapy (GDMT) (comprising dual antiplatelet therapy, a β-blocker, and a statin) and 57% were discharged on five guideline-directed medical treatment (the combination of dual antiplatelet therapy, a β-blocker, an ACEIs or an ARB, and a statin). Conclusion Optimal secondary prevention medications are known to be effective in reducing the risk of repeat ischemic events in ACS. This study demonstrated that adherence to GDMT in our community-based hospital study is better compared to prior studies but remained suboptimal. Potential strategies to improve adherence to guidelines are necessary.
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spelling pubmed-74496382020-08-28 Use of Guideline-Directed Medical Therapy in Patients With ST-Elevation Myocardial Infarction Latifi, Ahmad Nawid Akram, Abeera Dengle, Samir Minhas, Amjad Borz-Baba, Carolina Cureus Cardiology Introduction ST-elevation myocardial infarction (STEMI) is a serious manifestation of coronary artery disease and remains a significant contributor to morbidity and mortality worldwide. To reduce the risk of recurrent cardiovascular disease (CVD) events, the American College of Cardiology (ACC) and American Heart Association (AHA) recommend the use of five classes of medications after acute coronary syndrome (ACS). The purpose of this study was to evaluate whether STEMI patients admitted to our community hospital were discharged on optimal medical therapy based on the latest AHA/ACC guidelines. Methods A retrospective, single-center electronic medical records review was conducted at our community hospital between July 2017 and December 2018. Patients included in the study were admitted to our hospital through the emergency department as STEMI alerts. We reviewed the discharge prescriptions and assessed compliance with the medication regimen endorsed by AHA/ACC, which includes aspirin, P2Y12 inhibitors, β-blockers, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and statins. Results A total of 147 patients were included in our study. The mean age of our study population was 62 ± 12.48 years. 97.2% of all patients with STEMI underwent coronary angiography. Hypertension (65.9%) was the most common comorbidity followed by hyperlipidemia (54.42%), diabetes mellitus (29.25%), and history of coronary artery disease (CAD) (24.48%). Among patients with successful reperfusion, 87.4% of the patients received the combination of four guideline-directed medical therapy (GDMT) (comprising dual antiplatelet therapy, a β-blocker, and a statin) and 57% were discharged on five guideline-directed medical treatment (the combination of dual antiplatelet therapy, a β-blocker, an ACEIs or an ARB, and a statin). Conclusion Optimal secondary prevention medications are known to be effective in reducing the risk of repeat ischemic events in ACS. This study demonstrated that adherence to GDMT in our community-based hospital study is better compared to prior studies but remained suboptimal. Potential strategies to improve adherence to guidelines are necessary. Cureus 2020-07-26 /pmc/articles/PMC7449638/ /pubmed/32864229 http://dx.doi.org/10.7759/cureus.9398 Text en Copyright © 2020, Latifi et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Latifi, Ahmad Nawid
Akram, Abeera
Dengle, Samir
Minhas, Amjad
Borz-Baba, Carolina
Use of Guideline-Directed Medical Therapy in Patients With ST-Elevation Myocardial Infarction
title Use of Guideline-Directed Medical Therapy in Patients With ST-Elevation Myocardial Infarction
title_full Use of Guideline-Directed Medical Therapy in Patients With ST-Elevation Myocardial Infarction
title_fullStr Use of Guideline-Directed Medical Therapy in Patients With ST-Elevation Myocardial Infarction
title_full_unstemmed Use of Guideline-Directed Medical Therapy in Patients With ST-Elevation Myocardial Infarction
title_short Use of Guideline-Directed Medical Therapy in Patients With ST-Elevation Myocardial Infarction
title_sort use of guideline-directed medical therapy in patients with st-elevation myocardial infarction
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449638/
https://www.ncbi.nlm.nih.gov/pubmed/32864229
http://dx.doi.org/10.7759/cureus.9398
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