Key result
Appropriate secondary prevention at discharge linked to ~36% lower 5-year MACE, particularly in high-risk patients.
Why the study?
Does appropriate secondary prevention treatment at discharge reduce major adverse cardiovascular events at five years in patients after acute myocardial infarction across different atherothrombotic risk strata?
Cohort (n=4,169)
Yes
Does appropriate secondary prevention treatment at discharge reduce major adverse cardiovascular events at five years in patients after acute myocardial infarction across different atherothrombotic risk strata?
Hazard Ratio: 0.64 (95% CI 0.52–0.79)
p-value: p=<0.001
Appropriate secondary prevention treatment at discharge is underutilized, particularly in high-risk post-MI patients, where it provides the greatest reduction in 5-year major adverse cardiovascular events.
Appropriate secondary prevention was associated with lower 5-year MACE especially in high-risk patients; supports targeted prescription but leaves open need for randomized confirmation.
BACKGROUND: Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction. DESIGN: The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. METHODS: We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated). RESULTS: Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59-1.12, p = 0.21) in group 1, 0.74 (0.54-1.01; p = 0.06) in group 2, and 0.64 (0.52-0.79, p < 0.001) in group 3. CONCLUSIONS: Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.
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Tea et al. (2018) conducted a cohort in acute myocardial infarction (n=4,169). Appropriate secondary prevention treatment at discharge vs. Lack of appropriate secondary prevention treatment was evaluated on Major adverse cardiovascular events (death, re-myocardial infarction or stroke) (HR 0.64, 95% CI 0.52-0.79, p=<0.001). Appropriate secondary prevention treatment at discharge was associated with lower 5-year rates of MACE, particularly in high-risk patients (HR 0.64; 95% CI 0.52-0.79; P<0.001).
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