Key result
Optimal medical therapy at discharge significantly reduced all-cause mortality compared to non-OMT in patients with acute myocardial infarction post-PCI (aHR 0.82; 95% CI 0.76-0.90; P<0.001).
Why the study?
The prescription rate of optimal medical therapy at discharge and its impact on long-term clinical outcomes remained to be evaluated in patients with acute myocardial infarction undergoing percutaneous coronary intervention in the drug-eluting stent era.
Does guideline-based optimal medical therapy reduce all-cause mortality in patients with acute myocardial infarction after percutaneous coronary intervention?
Cohort (n=35,972)
Yes
Does guideline-based optimal medical therapy reduce all-cause mortality in patients with acute myocardial infarction after percutaneous coronary intervention?
Guideline-directed optimal medical therapy at discharge significantly reduces long-term all-cause mortality and the composite of death or coronary revascularization in patients with acute myocardial infarction after PCI.
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.
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Lee et al. (2023) conducted a cohort in Acute myocardial infarction (n=35,972). Optimal medical therapy (OMT) vs. Non-OMT was evaluated on All-cause death (aHR 0.82, 95% CI 0.76-0.90, p=<0.001). Optimal medical therapy at discharge significantly reduced all-cause mortality compared to non-OMT in patients with acute myocardial infarction post-PCI (aHR 0.82; 95% CI 0.76-0.90; P<0.001).
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