Key result
A 3-drug secondary prevention regimen without beta-blockers was associated with a similar risk of ACS recurrence or death compared to a 4-drug regimen (Risk 0.99; 95% CI 0.89-1.10).
Why the study?
Does the use of incomplete evidence-based cardiovascular medication combinations compared to the four recommended EBCMs affect the risk of ACS recurrence or death in patients after first acute coronary syndrome?
Cohort (n=31,668)
Yes
Does the use of incomplete evidence-based cardiovascular medication combinations compared to the four recommended EBCMs affect the risk of ACS recurrence or death in patients after first acute coronary syndrome?
Effect estimate: Risk 0.99 (95% CI 0.89-1.10)
Omitting beta-blockers from the four recommended evidence-based cardiovascular medications for post-ACS secondary prevention did not increase the risk of ACS recurrence or death, questioning their long-term necessity.
Long-term effectiveness of evidence-based cardiovascular medications (EBCMs) indicated after acute coronary syndrome (ACS) needs to be assessed considering the combination effects for these drugs recommended in association. Using a nationwide database, we conducted a cohort study to evaluate the effectiveness of all possible incomplete EBCMs-based combinations as compared to that associating the four recommended EBCMs over up to 5 years of follow-up. Among the 31,668 patients included, 22.9% had ACS recurrence or died during follow-up. The risks associated with the use of 3-EBCM based combinations were 1.46 (95% confidence interval: 1.33-1.60) for the combinations without statins, 1.30 (1.17-1.43) for the combinations without angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 1.11 (0.98-1.25) for the combinations without antiplatelet agents, and 0.99 (0.89-1.10) for the combination without beta-blockers. These findings question the interest of maintaining long-term treatment with beta-blockers in addition to the other EBCMs for post-ACS secondary prevention.
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Bezin et al. (2017) conducted a cohort in Acute coronary syndrome (n=31,668). 3-drug cardiovascular medication combinations without beta-blockers vs. 4-drug recommended evidence-based cardiovascular medications was evaluated on ACS recurrence or death (Risk 0.99, 95% CI 0.89-1.10). A 3-drug secondary prevention regimen without beta-blockers was associated with a similar risk of ACS recurrence or death compared to a 4-drug regimen (Risk 0.99; 95% CI 0.89-1.10).
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