Adherence to guideline-directed medical therapy and 3-year clinical outcome following acute myocardial infarction

Figures

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  Figure 1. Study flow. The 3-year clinical outcomes of patients with guideline-directed medical therapy and those without guideline-directed medical therapy were compared. In addition to unadjusted analysis, propensity score matching- and inverse probability of treatment-weighting-adjusted analyses were performed to assess the average treatment effect on the control and average treatment effect estimands.

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  Figure 2. Trends of change in the adherence to guideline-directed medical therapy during clinical follow-up. Sankey diagram showing decreasing trends of adherence to guideline-directed medical therapy, from 70.2% at discharge to 54.6% at 3-year. The rate of crossover between guideline-directed medical therapy and no guideline-directed medical therapy was 25.7, 13.9, and 11.3% at 1-year, 2-year, and 3-year, respectively.

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  Figure 3. Patients with guideline-directed medical therapy vs. those without guideline-directed medical therapy: unadjusted cumulative incidence of events. In this unadjusted analysis, compared with patients without guideline-directed medical therapy, the risks of major adverse cardiovascular events, death, and non-fatal major adverse cardiovascular events were 0.5-, 0.3-, and 0.9-fold lower in patients with guideline-directed medical therapy (A–C). The risks of the components of non-fatal major adverse cardiovascular events, including myocardial infarction, revascularization, and stroke, were not different or marginally lower in patients with guideline-directed medical therapy (D–F).

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  Figure 4. Patients with guideline-directed medical therapy vs. those without guideline-directed medical therapy: propensity score matching-adjusted cumulative incidence of events. In this propensity score matching-adjusted analysis, the risks of major adverse cardiovascular events and death were 0.8- and 0.6-fold lower in patients with guideline-directed medical therapy (A, B). The risks of non-fatal major adverse cardiovascular events and the components of non-fatal major adverse cardiovascular events, including myocardial infarction, revascularization, and stroke, were not different between two groups (C–F).

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  Figure 5. Forest plots of hazard ratio: unadjusted and propensity score matching-adjusted comparison of patients with guideline-directed medical therapy vs. those without guideline-directed medical therapy in 0-, 1-, and 2-year landmark analyses. In both unadjusted and propensity score matching-adjusted analyses, the risks of major adverse cardiovascular events and death were lower in patients with guideline-directed medical therapy (A, B). These findings were consistent in analysis in 1- or 2-year landmark analyses (C–F).

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  Figure 6. Forest plots of restricted mean survival time difference: unadjusted and propensity score matching-adjusted comparison of patients with guideline-directed medical therapy vs. those without guideline-directed medical therapy in 0-, 1-, and 2-year landmark analyses. In both unadjusted and propensity score matching-adjusted analyses, restricted mean survival time of patients with guideline-directed medical therapy regarding major adverse cardiovascular events and death were significantly longer than those without guideline-directed medical therapy (A, B). These findings were consistent in analysis in 1- or 2-year landmark analyses (C–F).