Key result
Complete guideline adherence in patients with acute myocardial infarction was associated with a lower risk of adverse cardiovascular events compared to low adherence (HR 0.66; 95% CI 0.52-0.85; P=0.001).
Why the study?
The association between guideline adherence and long-term outcomes in patients with acute myocardial infarction in real-world clinical practice remained unclear.
Does complete adherence to guideline-recommended therapies reduce adverse cardiovascular events in patients with acute myocardial infarction?
Cohort (n=2,757)
Yes
Does complete adherence to guideline-recommended therapies reduce adverse cardiovascular events in patients with acute myocardial infarction?
Complete adherence to guideline-recommended therapies in patients with acute myocardial infarction is associated with a significant reduction in long-term adverse cardiovascular events.
Supports full guideline adherence to lower post-MI events; leaves open causality pending randomized confirmation.
Background: The association between guideline adherence and long-term outcomes in patients with acute myocardial infarction in real-world clinical practice remains unclear. Methods: We investigated 3283 consecutive patients with acute myocardial infarction who were selected from a prospective, nation-wide, multicentre registry (J-MINUET) database covering 28 institutions in Japan between July 2012 and March 2014. Among the 2757 eligible patients, we evaluated the use of seven guideline-recommended therapies, including urgent revascularisation, door-to-balloon time of 90 minutes or less, and five discharge medications (P2Y12 inhibitors on aspirin, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, lipid-lowering drugs). The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure and urgent revascularisation for unstable angina up to 3 years. Results: The overall median composite guideline adherence was 85.7%. Patients were divided into the following three groups: complete (100%) adherence group (n=862); moderate adherence (75% to <100%) group (n=911); and low adherence (0–75%) group (n=984). The rate of adverse cardiovascular events was significantly lower in the complete adherence group than in the low and moderate adherence groups (log rank P<0.0001). Multivariate Cox regression analysis showed complete guideline adherence was also significantly associated with lower adverse cardiovascular events compared with low guideline adherence (hazard ratio 0.66; 95% confidence interval 0.52–0.85; P=0.001). Conclusion: The use of guideline-based therapies for patients with acute myocardial infarction in contemporary clinical practice was associated with significant decreases in adverse long-term clinical outcomes. Trial registration: UMIN Unique trial Number: UMIN000010037
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Wada et al. (2020) conducted a cohort in acute myocardial infarction (n=2,757). Complete guideline adherence vs. Low guideline adherence was evaluated on composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure and urgent revascularisation for unstable angina (HR 0.66, 95% CI 0.52-0.85, p=0.001). Complete guideline adherence in patients with acute myocardial infarction was associated with a lower risk of adverse cardiovascular events compared to low adherence (HR 0.66; 95% CI 0.52-0.85; P=0.001).
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