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

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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, Senges, J, Tebbe, U·2010·Heart

DOI 10.1136/hrt.2009.188607

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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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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
ORCID: Bramlage, P
Bitterlich, N
Cuneo, A
Senges, J
Venue: Heart
Publisher: BMJ
Published: 2010-03-29
Volume: 96
Issue: 8
Pages: 604-609
ISSN: 1355-6037 (ISSN-L)
1468-201X
DOI: 10.1136/hrt.2009.188607
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: bronze
doi.org
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 › Cardiology and Cardiovascular Medicine › 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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The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction

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