Cited by 115Acute Myocardial Infarction ResearchAntiplatelet Therapy and Cardiovascular DiseasesCoronary Interventions and Diagnostics

The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction

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Bramlage, P, Messer, C, Bitterlich, N, Pohlmann, C, Cuneo, A, Stammwitz, E, Tebbenjohanns, J, Gohlke, H +2 more·2010·Heart

Abstract

Objectives: Five drug classes have been shown to improve the prognosis of acute myocardial infarction in clinical trials: aspirin, β-blockers, statins, renin angiotensin system (RAS) blockers and thienopyridines. We aimed to assess whether the benefits of combining these drugs (termed optimal medical therapy, OMT), will result in a reduction of mortality in clinical practice. Design: Nationwide registry Setting: Hospitals with a cardiology unit or internal medicine department. Patients: 5353 patients with acute myocardial infarction. At hospital discharge 89% received aspirin, 90% β-blockers, 84% statins, 81% RAS blockers, 70% a thienopyridine and 46.2% OMT. Interventions: Pharmacotherapy Main outcome measures: OR with 95% CI for mortality from myocardial infarction were calculated and adjusted for patient risk at baseline. Results: Total mortality was reduced by 74% in patients receiving OMT (adj OR 0.26; 95% CI 0.18 to 0.38) versus patients receiving one or no drug. This was consistent in subgroups defined by STEMI/NSTEMI, diabetes and gender. Mortality was also reduced in patients receiving 2–4 drugs (adj OR 0.49; 95% CI 0.35 to 0.68), diabetic patients being the only subgroup with no significant effect. Analyses on the relative importance of either component revealed that withdrawal of β-blockers (adj OR 0.63; 95% CI 0.34 to 1.16) and/or a combination of aspirin/clopidogrel (adj OR 0.59; 95% CI 0.20 to 1.17) abolished the risk reduction conferred by OMT. Conclusions: OMT over 1 year was associated with a significantly lower mortality of patients with acute myocardial infarction in clinical practice. However OMT is provided to less than half of eligible patients leaving room for substantial improvement.

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  1. Heart 2010;96:604e609. doi:10.1136/hrt.2009.188607 Acute coronary syndrome on August 24, 2023 by guest. Protected by copyright. http://heart.bmj.com/ Heart: first published as 10.1136/hrt.2009.188607 on 29 March 2010. Downloaded from REFERENCES
  2. Tebbe U, Messer C, Stammwitz E, et al. [Reduction of in-hospital mortality and improved secondary prevention after acute myocardial infarction. First results from the registry of secondary prevention after acute myocardial infarction (SAMI)]. Dtsch Med Wochenschr 2007;132:1559e66.

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Authors
Bramlage, P., Messer, C., Bitterlich, N., Pohlmann, C., Cuneo, A., Stammwitz, E., Tebbenjohanns, J., Gohlke, H., Senges, J., & Tebbe, U.
Affiliations
  • Klinikum Lippe (DE)
  • Klinikum Lüdenscheid (DE)
  • Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE)
  • Heidelberg University (DE)
Corresponding author
Tebbe, U
Venue
Heart
Publisher
BMJ
Published
2010-03-29
Volume
96
Issue
8
Pages
604-609
ISSN
  • 1355-6037 (ISSN-L)
  • 1468-201X
OpenAlex
W2162467404
Cited by
115
References
31
Citations by year
2024: 1 · 2023: 9 · 2022: 2 · 2021: 6 · 2020: 8 · 2019: 5 · 2018: 2 · 2017: 5 · 2016: 13 · 2015: 4 · 2014: 11 · 2013: 14 · 2012: 15
FWCI
10.56
Type
journal article
Language
en
Open access
Locations
  • Heart (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
Keywords
acute myocardial infarction, optimal medical therapy, one-year mortality, aspirin, beta-blockers, statins, renin-angiotensin system inhibitors, thienopyridines, clopidogrel, drug combination therapy, diabetes mellitus, guideline adherence, pharmacotherapy
MeSH terms
Aged, Cardiovascular Agents, Drug Therapy, Combination, Female, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies

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