Suboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: Prescription rate, predictors, and prognostic value
- Jang Hoon Lee; Dong Heon Yang; Hun Sik Park; Yongkeun Cho; Myung Ho Jeong; Young Jo Kim; Kee-Sik Kim; Seung Ho Hur; In Whan Seong; Taek Jong Hong; Myeong Chan Cho; Chong Jin Kim; MD; Jae-Eun Jun; Wee-Hyun Park; Shung Chull Chae
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- Background Only limited data are available for the recent trend of optimal evidence-based medical therapy at
discharge after acute myocardial infarction (AMI) in Asia. We evaluated the predictors for the use of optimal evidence-based
medical therapy at discharge and the association between discharge medications and 6-month mortality after AMI.
Methods Between November 2005 and January 2008, we evaluated the discharge medications among 9,294 post-MI
survivors who did not have any documented contraindications to antiplatelet drugs, β-blockers, angiotensin-converting enzyme
inhibitors (ACE-Is)/angiotensin II receptor blockers (ARBs), or statins in the Korea Acute Myocardial Infarction Registry.
Optimal evidence-based medical therapy was defined as the use of all 4 indicated medications.
Results Of these patients, 4,684 (50.4%) received all 4 medications at discharge. The discharge prescription rates of
antiplatelet drugs, β-blockers, ACE-Is/ARBs, and statins were 99.0%, 72.7%, 81.5%, and 77.2%, respectively. In multivariate
analysis, advanced age, lower systolic blood pressure, higher Killip class at admission, left ventricular systolic dysfunction, higher
blood creatinine level, lower total cholesterol levels, and coronary artery bypass grafting during hospitalization were
independently associated with less use of optimal evidence-based medical therapy. In contrast, patients who underwent
percutaneous coronary intervention were more likely to use optimal medications. In Cox proportional hazards model, optimal
evidence-based medical therapy was an independent predictor of 6-month mortality after adjusting clinical characteristics and
angiographic and procedural data.
Conclusions The optimal evidence-based medical therapy is prescribed at suboptimal rates, particularly in patients with
high-risk features. New educational strategies are needed to increase the use of these secondary preventive medical therapies.
(Am Heart J 2010;159:1012-9.)
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