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Long-term survival in patients with different combinations of evidence-based medications after incident acute myocardial infarction: results from the MONICA/KORA Myocardial Infarction Registry.
Clin Res Cardiol. 2014 Aug; 103(8):655-64.CR

Abstract

BACKGROUND

Use of the four evidence-based medications [EBMs: antiplatelet agent, beta-blocker, statin and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB)] after acute myocardial infarction (AMI) has a clear impact on 1-year survival. Aim of this study was to evaluate the association between different EBM combinations at discharge and long-term survival after AMI.

METHODS

From a German population-based AMI registry, 2,886 men and 958 women were included, aged 28-74 years, hospitalized with an incident AMI between 2000 and 2008. All data were collected by standardized interviews and chart review. All-cause mortality was assessed for all registered persons in 2010. Median follow-up time was 6.0 years (interquartile range 4.1 years). Survival analyses and multivariate Cox regression analysis were conducted.

RESULTS

Of the 3,844 patients, 70.3 % were prescribed all four EBMs; 23.8 % received three, 4.6 % two, and 1.3 % were discharged with one or no EBM. Long-term survival was 71.7 % [95 % confidence interval (CI) 55.4-82.9 %], 64.7 % (95 % CI 59.2-69.6) and 60.2 % (95 % CI 51.9-67.5 %) in patients with four, three and <3 EBMs, respectively. Patients prescribed three or less EBMs without ACEI/ARB showed similar long-term survival to those receiving four EBMs. In Cox regression analysis after adjustment for confounding variables, the hazard ratio for long-term mortality in patients with four EBMs versus three or less EBMs was 0.63 (95 % CI 0.53-0.74).

CONCLUSIONS

Prescribing of a combination of all four EBMs appeared to improve clinical outcomes in AMI patients by significantly reducing long-term mortality. Hospital discharge is a critical time for optimal long-term management.

Authors+Show Affiliations

MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany, ute.amann@helmholtz-muenchen.de.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24604524

Citation

Amann, Ute, et al. "Long-term Survival in Patients With Different Combinations of Evidence-based Medications After Incident Acute Myocardial Infarction: Results From the MONICA/KORA Myocardial Infarction Registry." Clinical Research in Cardiology : Official Journal of the German Cardiac Society, vol. 103, no. 8, 2014, pp. 655-64.
Amann U, Kirchberger I, Heier M, et al. Long-term survival in patients with different combinations of evidence-based medications after incident acute myocardial infarction: results from the MONICA/KORA Myocardial Infarction Registry. Clin Res Cardiol. 2014;103(8):655-64.
Amann, U., Kirchberger, I., Heier, M., Golüke, H., von Scheidt, W., Kuch, B., Peters, A., & Meisinger, C. (2014). Long-term survival in patients with different combinations of evidence-based medications after incident acute myocardial infarction: results from the MONICA/KORA Myocardial Infarction Registry. Clinical Research in Cardiology : Official Journal of the German Cardiac Society, 103(8), 655-64. https://doi.org/10.1007/s00392-014-0688-0
Amann U, et al. Long-term Survival in Patients With Different Combinations of Evidence-based Medications After Incident Acute Myocardial Infarction: Results From the MONICA/KORA Myocardial Infarction Registry. Clin Res Cardiol. 2014;103(8):655-64. PubMed PMID: 24604524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term survival in patients with different combinations of evidence-based medications after incident acute myocardial infarction: results from the MONICA/KORA Myocardial Infarction Registry. AU - Amann,Ute, AU - Kirchberger,Inge, AU - Heier,Margit, AU - Golüke,Hildegard, AU - von Scheidt,Wolfgang, AU - Kuch,Bernhard, AU - Peters,Annette, AU - Meisinger,Christa, Y1 - 2014/03/07/ PY - 2013/12/04/received PY - 2014/02/12/accepted PY - 2014/3/8/entrez PY - 2014/3/8/pubmed PY - 2015/3/31/medline SP - 655 EP - 64 JF - Clinical research in cardiology : official journal of the German Cardiac Society JO - Clin Res Cardiol VL - 103 IS - 8 N2 - BACKGROUND: Use of the four evidence-based medications [EBMs: antiplatelet agent, beta-blocker, statin and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB)] after acute myocardial infarction (AMI) has a clear impact on 1-year survival. Aim of this study was to evaluate the association between different EBM combinations at discharge and long-term survival after AMI. METHODS: From a German population-based AMI registry, 2,886 men and 958 women were included, aged 28-74 years, hospitalized with an incident AMI between 2000 and 2008. All data were collected by standardized interviews and chart review. All-cause mortality was assessed for all registered persons in 2010. Median follow-up time was 6.0 years (interquartile range 4.1 years). Survival analyses and multivariate Cox regression analysis were conducted. RESULTS: Of the 3,844 patients, 70.3 % were prescribed all four EBMs; 23.8 % received three, 4.6 % two, and 1.3 % were discharged with one or no EBM. Long-term survival was 71.7 % [95 % confidence interval (CI) 55.4-82.9 %], 64.7 % (95 % CI 59.2-69.6) and 60.2 % (95 % CI 51.9-67.5 %) in patients with four, three and <3 EBMs, respectively. Patients prescribed three or less EBMs without ACEI/ARB showed similar long-term survival to those receiving four EBMs. In Cox regression analysis after adjustment for confounding variables, the hazard ratio for long-term mortality in patients with four EBMs versus three or less EBMs was 0.63 (95 % CI 0.53-0.74). CONCLUSIONS: Prescribing of a combination of all four EBMs appeared to improve clinical outcomes in AMI patients by significantly reducing long-term mortality. Hospital discharge is a critical time for optimal long-term management. SN - 1861-0692 UR - https://www.unboundmedicine.com/medline/citation/24604524/Long_term_survival_in_patients_with_different_combinations_of_evidence_based_medications_after_incident_acute_myocardial_infarction:_results_from_the_MONICA/KORA_Myocardial_Infarction_Registry_ L2 - https://dx.doi.org/10.1007/s00392-014-0688-0 DB - PRIME DP - Unbound Medicine ER -