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Original article
The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction
  1. P Bramlage1,
  2. C Messer2,
  3. N Bitterlich2,
  4. C Pohlmann1,
  5. A Cuneo3,
  6. E Stammwitz4,
  7. J Tebbenjohanns5,
  8. H Gohlke6,
  9. J Senges7,
  10. U Tebbe3
  1. 1Institute for Cardiovascular Pharmacology and Epidemiology, Mahlow, Germany
  2. 2DBM GmbH, Mühlhausen, Germany
  3. 3Klinikum Lippe GmbH, Fachbereich Herz-Kreislauf, Detmold, Germany
  4. 4Kreiskrankenhaus Leer, Leer, Germany
  5. 5Klinikum Hildesheim GmbH, Hildesheim, Germany
  6. 6Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
  7. 7Stiftung Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
  1. Correspondence to Professor Dr med Ulrich Tebbe, Klinikum Lippe GmbH, Fachbereich Herz-Kreislauf, Röntgenstrasse 18, 32756 Detmold, Germany; ulrich.tebbe{at}klinikum-lippe.de

Abstract

Objectives Five drug classes have been shown to improve the prognosis of acute myocardial infarction in clinical trials: aspirin, β-blockers, statins, renin angiotensin system (RAS) blockers and thienopyridines. We aimed to assess whether the benefits of combining these drugs (termed optimal medical therapy, OMT), will result in a reduction of mortality in clinical practice.

Design Nationwide registry

Setting Hospitals with a cardiology unit or internal medicine department.

Patients 5353 patients with acute myocardial infarction. At hospital discharge 89% received aspirin, 90% β-blockers, 84% statins, 81% RAS blockers, 70% a thienopyridine and 46.2% OMT.

Interventions Pharmacotherapy

Main outcome measures OR with 95% CI for mortality from myocardial infarction were calculated and adjusted for patient risk at baseline.

Results Total mortality was reduced by 74% in patients receiving OMT (adj OR 0.26; 95% CI 0.18 to 0.38) versus patients receiving one or no drug. This was consistent in subgroups defined by STEMI/NSTEMI, diabetes and gender. Mortality was also reduced in patients receiving 2–4 drugs (adj OR 0.49; 95% CI 0.35 to 0.68), diabetic patients being the only subgroup with no significant effect. Analyses on the relative importance of either component revealed that withdrawal of β-blockers (adj OR 0.63; 95% CI 0.34 to 1.16) and/or a combination of aspirin/clopidogrel (adj OR 0.59; 95% CI 0.20 to 1.17) abolished the risk reduction conferred by OMT.

Conclusions OMT over 1 year was associated with a significantly lower mortality of patients with acute myocardial infarction in clinical practice. However OMT is provided to less than half of eligible patients leaving room for substantial improvement.

  • Guidelines
  • myocardial infarction
  • registry
  • mortality

https://doi.org/10.1136/hrt.2009.188607

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    Footnotes

    • Funding The study has been funded by Solvay Pharma.

    • Competing interests SAMI was funded by an unrestricted educational grant from Solvay Arzneimittel, Hannover, Germany. Solvay had no active role in the preparation of neither this analysis nor the decision to publish the manuscript. UT, JS and PB have been actively involved in advisory boards and have received research grants of different pharmaceutical companies producing cardiovascular drugs for patients with acute myocardial infarction. The statistical analyses were performed by NB who is a named author on this manuscript.

    • Ethics approval This study was conducted with the approval of the Ärztekammer Westfalen-Lippe and the Westfälische Wilhelms Universität Münster.

    • Provenance and peer review Not commissioned; not externally peer reviewed.