Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke
Background: Treatment of acute myocardial infarction (AMI) patients with prior stroke is a common clinical dilemma. Currently, the application of optimal medical therapy (OMT) and its impact on clinical outcomes are not clear in this patient population. Methods: We retrieved 765 AMI patients with pr...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-09-01
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| Series: | Therapeutic Advances in Chronic Disease |
| Online Access: | https://doi.org/10.1177/20406223211046999 |
| _version_ | 1818888067348430848 |
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| author | Dongfeng Zhang Xiantao Song Sergio Raposeiras-Roubín Emad Abu-Assi Jose Paulo Simao Henriques Fabrizio D’Ascenzo Jorge Saucedo José Ramón González-Juanatey Stephen B. Wilton Wouter J. Kikkert Iván Nuñez-Gil Albert Ariza-Sole Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Shaoping Nie Toshiharu Fujii Luis Correia Masa-aki Kawashiri Danielle Southern Oliver Kalpak |
| author_facet | Dongfeng Zhang Xiantao Song Sergio Raposeiras-Roubín Emad Abu-Assi Jose Paulo Simao Henriques Fabrizio D’Ascenzo Jorge Saucedo José Ramón González-Juanatey Stephen B. Wilton Wouter J. Kikkert Iván Nuñez-Gil Albert Ariza-Sole Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Shaoping Nie Toshiharu Fujii Luis Correia Masa-aki Kawashiri Danielle Southern Oliver Kalpak |
| author_sort | Dongfeng Zhang |
| collection | DOAJ |
| description | Background: Treatment of acute myocardial infarction (AMI) patients with prior stroke is a common clinical dilemma. Currently, the application of optimal medical therapy (OMT) and its impact on clinical outcomes are not clear in this patient population. Methods: We retrieved 765 AMI patients with prior stroke who underwent percutaneous coronary intervention (PCI) during the index hospitalization from the international multicenter BleeMACS registry. All of the subjects were divided into two groups based on the prescription they were given prior to discharge. Baseline characteristics and procedural variables were compared between the OMT and non-OMT groups. Mortality, re-AMI, major adverse cardiovascular events (MACE), and bleeding were followed-up for 1 year. Results: Approximately 5% of all patients presenting with AMI were admitted to the hospital for ischemic stroke. Although the prescription rate of each OMT medication was reasonably high (73.3%–97.3%), 47.7% lacked at least one OMT medication. Patients receiving OMT showed a significantly decreased occurrence of mortality (4.5% vs 15.1%, p < 0.001), re-AMI (4.2% vs 9.3%, p = 0.004), and the composite endpoint of death/re-AMI (8.6% vs 20.5%, p < 0.001) compared to those without OMT. No significant difference was observed between the groups regarding bleeding. After adjusting for confounding factors, OMT was the independent protective factor of 1-year mortality, while age was the independent risk factors. Conclusions: OMT at discharge was associated with a significantly lower 1-year mortality of patients with AMI and prior stroke in clinical practice. However, OMT was provided to just half of the eligible patients, leaving room for substantial improvement. Clinical Trial Registration: NCT02466854 |
| first_indexed | 2024-12-19T16:47:14Z |
| format | Article |
| id | doaj.art-1ed66cc14044431b9d2c3eb3e54f796c |
| institution | Directory Open Access Journal |
| issn | 2040-6231 |
| language | English |
| last_indexed | 2024-12-19T16:47:14Z |
| publishDate | 2021-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Chronic Disease |
| spelling | doaj.art-1ed66cc14044431b9d2c3eb3e54f796c2022-12-21T20:13:38ZengSAGE PublishingTherapeutic Advances in Chronic Disease2040-62312021-09-011210.1177/20406223211046999Evaluation of optimal medical therapy in acute myocardial infarction patients with prior strokeDongfeng ZhangXiantao SongSergio Raposeiras-RoubínEmad Abu-AssiJose Paulo Simao HenriquesFabrizio D’AscenzoJorge SaucedoJosé Ramón González-JuanateyStephen B. WiltonWouter J. KikkertIván Nuñez-GilAlbert Ariza-SoleDimitrios AlexopoulosChristoph LiebetrauTetsuma KawajiClaudio MorettiZenon HuczekShaoping NieToshiharu FujiiLuis CorreiaMasa-aki KawashiriDanielle SouthernOliver KalpakBackground: Treatment of acute myocardial infarction (AMI) patients with prior stroke is a common clinical dilemma. Currently, the application of optimal medical therapy (OMT) and its impact on clinical outcomes are not clear in this patient population. Methods: We retrieved 765 AMI patients with prior stroke who underwent percutaneous coronary intervention (PCI) during the index hospitalization from the international multicenter BleeMACS registry. All of the subjects were divided into two groups based on the prescription they were given prior to discharge. Baseline characteristics and procedural variables were compared between the OMT and non-OMT groups. Mortality, re-AMI, major adverse cardiovascular events (MACE), and bleeding were followed-up for 1 year. Results: Approximately 5% of all patients presenting with AMI were admitted to the hospital for ischemic stroke. Although the prescription rate of each OMT medication was reasonably high (73.3%–97.3%), 47.7% lacked at least one OMT medication. Patients receiving OMT showed a significantly decreased occurrence of mortality (4.5% vs 15.1%, p < 0.001), re-AMI (4.2% vs 9.3%, p = 0.004), and the composite endpoint of death/re-AMI (8.6% vs 20.5%, p < 0.001) compared to those without OMT. No significant difference was observed between the groups regarding bleeding. After adjusting for confounding factors, OMT was the independent protective factor of 1-year mortality, while age was the independent risk factors. Conclusions: OMT at discharge was associated with a significantly lower 1-year mortality of patients with AMI and prior stroke in clinical practice. However, OMT was provided to just half of the eligible patients, leaving room for substantial improvement. Clinical Trial Registration: NCT02466854https://doi.org/10.1177/20406223211046999 |
| spellingShingle | Dongfeng Zhang Xiantao Song Sergio Raposeiras-Roubín Emad Abu-Assi Jose Paulo Simao Henriques Fabrizio D’Ascenzo Jorge Saucedo José Ramón González-Juanatey Stephen B. Wilton Wouter J. Kikkert Iván Nuñez-Gil Albert Ariza-Sole Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Shaoping Nie Toshiharu Fujii Luis Correia Masa-aki Kawashiri Danielle Southern Oliver Kalpak Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke Therapeutic Advances in Chronic Disease |
| title | Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke |
| title_full | Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke |
| title_fullStr | Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke |
| title_full_unstemmed | Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke |
| title_short | Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke |
| title_sort | evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke |
| url | https://doi.org/10.1177/20406223211046999 |
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