Key result
Among 21,181 MI patients, overall 28-day and 3-year survival rates were 0.95 (95% CI: 0.95-0.96) and 0.82 (95% CI: 0.81-0.82), with survival varying by discharge medication combination.
Why the study?
Secondary prevention pharmacotherapy is recommended after acute MI to reduce cardiovascular events and death, in a setting where CAD is a leading cause of death in Iran.
Do specific combinations of discharge medications improve short- and long-term survival in patients following acute myocardial infarction?
Cohort (n=21,181)
Yes
Do specific combinations of discharge medications improve short- and long-term survival in patients following acute myocardial infarction?
Optimal combinations of guideline-directed medical therapies at discharge are associated with improved short- and long-term survival following acute myocardial infarction.
Survival differs by discharge regimen in Iranian MI registry patients; leaves open optimal combinations for prospective trials.
BACKGROUND: Coronary artery disease is among the first causes of death in Iran. Secondary prevention with drug therapy is recommended following acute myocardial infarction (MI) to reduce the risk of new cardiovascular events and death. METHODS: This is a retrospective cohort study on data collected from 21181 cases of MI recorded by the MI Registry of Iran from 2013 to 2014. Ten therapies that were prescribed to patients at the time of discharge were divided into 6 groups. Survival rates were estimated using the Kaplan-Meier method and Cox regression analysis. RESULTS: The most common MI location was in the anterior wall (31.87%). Anticoagulants, aspirin, clopidogrel were the most common prescribed medications (94.73%). Overall, 28-day (short-term) and 3-year survival rates were 0.95 (95% CI: 0.95-0.96) and 0.82 (95% CI: 0.81-0.82). In non-ST-elevation myocardial infarction (NSTEMI) patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants/ aspirin and clopidogrel, beta-blockers and statins medication were simultaneously taken and the highest short- and long-term survival rates were observed in patients who took anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers and statins medication. In STEMI patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) were simultaneously taken. The highest short- and long-term survival rates were observed in patients who received anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers, statins, ACEIs and ARBs. CONCLUSION: Prescription of the best combination of drugs, in addition to adherence to a healthy lifestyle and medication, can improve the survival rates after MI.
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Mozaffarian et al. (2022) conducted a cohort in acute myocardial infarction (MI) (n=21,181). Discharge medications vs. Other medication combinations was evaluated on 28-day and 3-year survival rates. Among 21,181 MI patients, overall 28-day and 3-year survival rates were 0.95 (95% CI: 0.95-0.96) and 0.82 (95% CI: 0.81-0.82), with survival varying by discharge medication combination.
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