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 therap...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024370 |
| _version_ | 1797822315164073984 |
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| author | Kyusup Lee Seungbong Han Myunhee Lee Dae‐Won Kim Jongbum Kwon Gyung‐Min Park Mahn‐Won Park |
| author_facet | Kyusup Lee Seungbong Han Myunhee Lee Dae‐Won Kim Jongbum Kwon Gyung‐Min Park Mahn‐Won Park |
| author_sort | Kyusup Lee |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-13T10:06:10Z |
| format | Article |
| id | doaj.art-22e83289760f4449937563547a275126 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T10:06:10Z |
| publishDate | 2023-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-22e83289760f4449937563547a2751262023-05-22T11:34:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-05-01121010.1161/JAHA.121.024370Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary InterventionKyusup Lee0Seungbong Han1Myunhee Lee2Dae‐Won Kim3Jongbum Kwon4Gyung‐Min Park5Mahn‐Won Park6Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of KoreaDepartment of Biostatistics, College of Medicine Korea University Seoul Republic of KoreaCardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of KoreaCardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of KoreaDepartment of Thoracic and Cardiovascular Surgery, Daejeon St. Mary’s Hospital The Catholic University of Korea Daejeon Republic of KoreaDepartment of Cardiology, Ulsan University Hospital University of Ulsan College of Medicine Ulsan Republic of KoreaCardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of KoreaBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.121.024370acute myocardial infarctiondrug‐eluting stentoptimal medical therapyoutcome |
| spellingShingle | Kyusup Lee Seungbong Han Myunhee Lee Dae‐Won Kim Jongbum Kwon Gyung‐Min Park Mahn‐Won Park Evidence‐Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute myocardial infarction drug‐eluting stent optimal medical therapy outcome |
| 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 | acute myocardial infarction drug‐eluting stent optimal medical therapy outcome |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024370 |
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