Association of treatments for acute myocardial infarction and survival for seven common comorbidity states: a nationwide cohort study
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Key result
Optimal AMI care is linked to ~47% lower mortality in patients without comorbidities, but not HF.
- HR 0.53
- 95% CI 0.51-0.56
- n=693,388
Why the study?
Comorbidity negatively impacts acute myocardial infarction prognosis, but the extent to which comorbidities influence guideline-indicated treatment provision and efficacy was unknown.
Does receipt of optimal guideline-indicated care for AMI improve long-term survival across different comorbidity states?
Population
693,388 AMI patients in MINAP (2003-2013)
Comparison
Receipt of optimal care vs non-receipt across seven common comorbidities
Design
Nationwide cohort study
Authors
Discussion
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Implication
Optimal care was associated with AMI survival benefit except in heart failure or cerebrovascular disease; leaves open need for targeted strategies in these subgroups.
Study Design
Type
Cohort (n=693,388)
Multicenter
Yes
Structured PICO
Does receipt of optimal guideline-indicated care for AMI improve long-term survival across different comorbidity states?
P
Population
693,388 adults aged 18 and older hospitalized with acute myocardial infarction in England and Wales, followed for a median of 2.25 years to assess the impact of comorbidities on treatment and survival.
E
Exposure
Receipt of optimal care for AMI (receipt of all eligible guideline-indicated treatments)
C
Comparator
Non-receipt of optimal care
O
Outcome
Long-term survivalhard clinical
Main Result
Hazard Ratio: 0.53 (95% CI 0.51–0.56)
Guideline-indicated care for AMI improves survival in most patients, but its benefit is attenuated or absent in those with pre-existing heart failure or cerebrovascular disease.
Limitations
- Reliant upon the accurate recording of data and comorbidities in the MINAP registry.
- Not all cases of NSTEMI in England and Wales are entered in the registry.
- Strict 'all or none' definition of optimal care could misclassify some patients.
- Lack of data on post-AMI hospital admissions to account for competing events.
- Analyses were restricted to all-cause mortality rather than cause-specific mortality.
Cite This Study
Yadegarfar et al. (2020) conducted a cohort in Acute myocardial infarction (n=693,388). Receipt of optimal guideline-indicated care for AMI vs. Suboptimal care was evaluated on Long-term survival (all-cause mortality) (HR 0.53, 95% CI 0.51-0.56). Receipt of optimal guideline-indicated care for acute myocardial infarction improved survival for patients without comorbidities (HR 0.53) but showed no benefit for those with heart failure or stroke.
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