Treatment With Cardiovascular Medications: Prognosis in Patients With Myocardial Injury

BACKGROUND: There is no clinical guidance on treatment in patients with non‐ischemic myocardial injury and type 2 myocardial infarction (T2MI). METHODS AND RESULTS: In a cohort of 22 589 patients in the emergency department at Karolinska University Hospital in Sweden during 2011 to 2014 we identified 3853 patients who were categorized into either type 1 myocardial infarction, T2MI, non‐ischemic acute and chronic myocardial injury. Data from all dispensed prescriptions within 180 days of the visit to the emergency department were obtained concerning β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers, statins, and platelet inhibitors. We estimated adjusted hazard ratios (HR) with 95% CI for all‐cause mortality in relationship to the number of medications (categorized into 0–1 [referent], 2–3 and 4 medications) in the groups of myocardial injury. In patients with T2MI, treatment with 2 to 3 and 4 medications was associated with a 50% and 56% lower mortality, respectively (adjusted HR [95% CI], 0.50 [0.25–1.01], and 0.43 [0.19–0.96]), while corresponding associations in patients with acute myocardial injury were 24% and 29%, respectively (adjusted HR [95% CI], 0.76 [0.59–0.99] and 0.71 [0.5–1.02]), and in patients with chronic myocardial injury 27% and 37%, respectively (adjusted HR [95% CI], 0.73 [0.58–0.92] and 0.63 [0.46–0.87]). CONCLUSIONS: Patients with T2MI and non‐ischemic acute or chronic myocardial injury are infrequently prescribed common cardiovascular medications compared with patients with type 1 myocardial infarction. However, treatment with guideline recommended drugs in patients with T2MI and acute or chronic myocardial injury is associated with a lower risk of death after adjustment for confounders.