Key result
2007 AMI care linked to ~44% lower in-hospital mortality vs. 2004, driven by statin and ACEi use.
Why the study?
Changes in management practices for AMI patients and their influence on short term hospital outcomes over time were not well characterized in Kuwait.
Does increased adherence to evidence-based therapies (statins, ACEi/ARB, clopidogrel) improve short-term in-hospital outcomes in patients with acute myocardial infarction?
Cohort (n=3,069)
Yes
Does increased adherence to evidence-based therapies (statins, ACEi/ARB, clopidogrel) improve short-term in-hospital outcomes in patients with acute myocardial infarction?
Odds Ratio: 1.8 (95% CI 1.2–2.7)
Absolute Event Rate: 2.2% vs 3.9%
p-value: p=0.0008
Increased utilization of evidence-based therapies for acute myocardial infarction between 2004 and 2007 was associated with significantly reduced in-hospital mortality and recurrent ischemia.
Lower in-hospital mortality accompanied increased evidence-based therapy use; supports association in AMI but leaves direct causality open.
AIM: To evaluate changes in management practices and its influence on short term hospital outcomes in patients with acute myocardial infarction (AMI) admitted during two different time periods, 2007 and 2004. METHODS AND RESULTS: We studied AMI patients from two acute coronary syndrome registries carried out in Kuwait in 2007 and 2004. We included 1872 and 1197 patients from the 2007 and 2004 registries, respectively. When compared with 2004, patients from the 2007 registry had similar baseline clinical characteristics. In 2007 compared to 2004, during the in-hospital period, patients with AMI received significantly more statins (94% vs. 73%%, p<0.0001), Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) (70% vs. 47%, p<0.001), and Clopidogrel (38% vs. 4%, p<0.001), while beta-blockers use dropped in 2007 compared to 2004 (63% vs. 68%, p=0.0066). The rates of in-hospital mortality and recurrent ischemia were significantly lower in the 2007 cohort compared with the 2004 cohort (for mortality 2.2% vs. 3.9%, P=0.0008, for recurrent ischemia 13.7% vs. 20.4%, P=0<0.0001).Higher utilization of angiotensin converting enzyme inhibitors, angiotensin receptor blockers and statins were the main contributors to the improved in-hospital mortality and morbidity. IN CONCLUSION: In the acute management of AMI, there was a significant increase in the use of statins, ACE inhibitors and Clopidogrel in 2007 compared to 2004. This was associated with a significant decrease in the in-hospital mortality and recurrent ischemia. Adherence to guidelines recommended therapies improved in-hospital outcomes.
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Mohammad Aljarallah (2011) conducted a cohort in Acute Myocardial Infarction (n=3,069). Admission in 2007 (increased use of evidence-based therapies) vs. Admission in 2004 was evaluated on All-cause in-hospital mortality (OR 1.8 (for 2004 vs 2007), 95% CI 1.2-2.7, p=0.0008). Admission for acute myocardial infarction in 2007 was associated with significantly lower in-hospital mortality (2.2% vs. 3.9%) compared to 2004, largely attributed to increased utilization of statins and ACE inhibitors.
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