ACUTE CORONARY SYNDROMES

Effect of drug combinations on admission for recurrent myocardial infarction

Menno E van der Elst¹, Marcel L Bouvy², Cornelis J de Blaey¹, Anthonius de Boer¹

¹ Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
² SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands

Dr M L Bouvy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands; m.l.bouvy{at}uu.nl

Objective: To determine the effect of the number of different drugs with adherence to medication of at least 70% on recurrent admission for myocardial infarction (MI) in patients with a history of MI.

Design: Nested case–control study in a dynamic cohort.

Setting: PHARMO database that contains pharmacy dispensing records and hospital discharge records of 350 000 Dutch citizens.

Subjects: All patients admitted to hospital for first MI (ICD-9 410) from 1991 to 2000 with at least a 30-day survival after admission. Cases were admitted for recurrent MI and were matched for age, sex, and year of admission with controls who did not have a recurrent MI.

Main outcome measure(s): Odds ratio with 95% CI for admission for recurrent MI. Exposure was the number of preventive drugs (antiplatelet agents, statins and ß blockers or ACE inhibitors) used for at least 70% of the time.

Results: 389 cases were matched with 2344 controls. The use of one drug was associated with a 6% odds reduction (95% CI 30% reduction to 28% increase) for admission for recurrent MI. The use of two or three drugs was associated with reductions of 26% and 41% (47% reduction to 3% increase and 6% to 63% reduction, respectively). Addition of one drug caused a 16% reduction (4% to 26%).

Conclusions: Multiple drug treatment decreases admissions for recurrent MI in patients with a history of MI. Every addition of a drug, regardless of drug class, reduces the risk even further. These results support the treatment strategies as applied in daily practice.

Abbreviations: CABG, coronary artery bypass grafting; CHF, chronic heart failure; MI, myocardial infarction; OR, odds ratio; PDC, percentage of days covered; PTCA, percutaneous transluminal coronary angioplasty

Keywords: myocardial infarction; secondary prevention; combination drug therapy

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