The rate of optimal guideline-recommended prescription for STEMI patients decreased from 74.3% at hospital discharge to 49.1% at 1-year follow-up, primarily due to statin dose reduction and early P2Y12 inhibitor discontinuation.
Observational (n=361)
No
While guideline-directed medical therapy prescription rates are high at discharge for STEMI patients, adherence declines significantly by 1 year, particularly for statins and P2Y12 inhibitors, with women and comorbid patients at highest risk for suboptimal therapy.
AIM: American and European associations of cardiology published specific guidelines about recommended drugs for secondary prevention in ST-segment elevation myocardial infarction (STEMI) patients. Our aim was to assess whether drug prescription for STEMI patients was in accordance with the guidelines at discharge and after 1 year. METHOD: We used data of 361 patients admitted for STEMI in a tertiary hospital in Switzerland from 2014 to 2016. We assessed the adequacy of prescription of recommended drugs at two time points: discharge and after 1 year. Medications assessed were aspirin, P2Y12 inhibitors, statin, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and β-blockers. We took into account several criteria like statin dosage (low versus high intensity) and presence of contraindication for consideration of optimal therapy. Predictors of incomplete prescription of guideline medications were then assessed with multivariate logistic regression models. RESULTS: From discharge (n = 358) to 1-year follow-up (n = 303), rate of optimal prescription was reduced from 98.6 to 91.7% for aspirin, from 93.9 to 79.1% for P2Y12 inhibitors, from 83.8 to 65.7% for statins, from 98.6 to 95.6% for ACEIs/ARBs, and from 97.1 to 96.9% for β-blockers. Predictors of incomplete prescription of guideline medications at discharge were female sex (odds ratio OR 2.54, p = 0.007), active or former smoker status (OR 2.29, p = 0.017), multivessel disease (OR 2.07, p = 0.022), left ventricular ejection fraction 65 (OR 1.92, p = 0.036) remained the only significant predictor. CONCLUSION: The present study showed a high prescription rate of guideline-recommended medications in a referral center for primary percutaneous coronary intervention. At discharge, women and co-morbid patients were at the highest risk of incomplete prescription of guideline medications, whereas long-term prescription was suboptimal for elderly. A drug lacking at time of discharge was rarely introduced within the year, which underscores the paramount importance of optimal prescription at time of discharge. Strategies like implementing a standardized prescription could reduce the proportion of suboptimal prescription. It could therefore be one way to improve the long-term quality of care of our patients to the highest level. This study used local data from AMIS Plus-National Registry of Acute Myocardial Infarction in Switzerland (NCT01305785).
Bruggmann et al. (Fri,) conducted a observational in ST-Segment Elevation Myocardial Infarction (STEMI) (n=361). Guideline-recommended secondary prevention medications was evaluated on Adequacy of prescription of recommended drugs at discharge and at 1 year. The rate of optimal guideline-recommended prescription for STEMI patients decreased from 74.3% at hospital discharge to 49.1% at 1-year follow-up, primarily due to statin dose reduction and early P2Y12 inhibitor discontinuation.