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ȣ - 520685 386 |
| Predictors and clinical outcomes of optimal medical therapy at discharge in patients with acute myocardial infarction |
| Korea Acute Myocardial infarction Registry Investigators |
| 이장훈, 정명호, 안영근, 채성철, 김종현, 성인환, 김영조, 허승호, 최동훈, 홍택종, 윤정한, 류제영, 채제건, 김두일, 채인호, 구본권, 김병옥, 이내희, 황진용, 오석규, 조명찬, 김기식, 정경태, 이명용, 김종진, 정욱성, 장양수, 승기배, 박승정 외 KAMIR 연구자 |
BACKGROUND AND OBJECTIVES: Only limited data are available for the recent trend of optimal evidence-based medical therapies (OMT) at discharge after acute myocardial infarction (AMI). We evaluated the predictors associated with OMT at discharge, and the association between the use of OMT at discharge and 6-month outcome. METHODS: Between November 2005 and January 2008, we evaluated the discharge medications among 9474 post-MI survivors (6827 men and 2647 women; mean age=63.8±12.5 year-old) who did not have any contraindications to anti-platelet agents, beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin II receptor blockers (ARB), or lipid-lowering drugs in the Korea Acute Myocardial Infarction Registry (KAMIR). OMT was defined as the use of all indicated medications. RESULTS: Of the 9474 patients, 4735 (50%) received OMT at the time of discharge. The discharge prescription rates of anti-platelet agents, BB, ACE-I/ARB and lipid-lowering drugs were 98.8%, 72.2%, 81.2%, and 76.9%, respectively. In multivariate analysis, old age (age ≥65)(odds ratio [OR] 0.854, 95% confidence interval [CI] 0.738 to 0.987, p=0.032), history of dyslipidemia (OR 1.382, 95%CI 1.107 to 1.726, p=0.004), percutaneous coronary intervention (PCI) (OR 1.970, 95%CI 1.629 to 2.382, p<0.001), and serum creatinine levels (OR 0.586, 95%CI 0.461 to 0.745, p<0.001) were independent predictors of OMT. Overall, 6-month mortality was 1.3%. The OMT group had significantly lower 6-month mortality (0.9% vs. 1.7%, p=0.001). In multivariate analysis, OMT (OR 0.045, 95%CI 0.425 to 0.990, p=0.045), old age (OR 3.596, 95%CI 2.070 to 6.245, p<0.001), Killip class ≥2 (OR 2.142, 95%CI 1.405 to 3.264, p<0.001), PCI (OR 0.522, 95%CI 0.334 to 0.816, p=0.004), serum creatinine levels (OR 2.095, 95%CI 1.168 to 3.759, p=0.013), and body mass index (OR 0.921, 95%CI 0.861 to 0.986, p=0.018) were independent predictors of 6-month mortality after adjustment for confounding variables. CONCLUSIONS: Only half of post-MI patients are receiving OMT at the time of discharge despite current guidelines for management of AMI. The OMT is an independent predictor of 6-month mortality.
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