TY - JOUR T1 - The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction JF - Heart JO - Heart SP - 604 LP - 609 DO - 10.1136/hrt.2009.188607 VL - 96 IS - 8 AU - P Bramlage AU - C Messer AU - N Bitterlich AU - C Pohlmann AU - A Cuneo AU - E Stammwitz AU - J Tebbenjohanns AU - H Gohlke AU - J Senges AU - U Tebbe Y1 - 2010/04/01 UR - http://heart.bmj.com/content/96/8/604.abstract N2 - 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 registrySetting 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 PharmacotherapyMain 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. ER -