Association between Adherence to Guideline-Recommended Preventive Medications and In-Hospital Mortality among Non-Reperfused ST-Elevation Myocardial Infarction Patients Admitted to a Tertiary Care Academic Center in a Developing Country

Abstract

Background and aims: Acute ST-elevation myocardial infarction (STEMI) is a potentially fatal presentation of coronary artery disease (CAD). Evidence of the impact of acute pharmacological interventions in non-reperfused STEMI patients on subsequent events is limited. We aimed to assess the association between adherence to guideline-recommended preventive medications and in-hospital mortality among this high-risk patient population. Methods: We conducted a cohort study using data obtained from the Jakarta Acute Coronary Syndrome (JAC) Registry database from a tertiary care academic hospital in Indonesia. We included 1132 of 2694 patients with STEMI recorded between 1 January 2014 and 31 December 2016 who did not undergo acute reperfusion therapy. Adherence to guidelinerecommended preventive medications was defined as the combined administration of aspirin, clopidogrel, anticoagulants and statins after hospital admission. The main outcome measure was in-hospital mortality. Results: Overall, 778 of 1132 patients (69%) received the combination of preventive medications. The guideline non-adherent group had significantly more patients with earlier onset of STEMI, higher Killip class and thrombolysis in myocardial infarction (TIMI) score. After adjustments for measured characteristics using logistic regression modeling, exposure to the combination of preventive therapies was associated with a statistically significant lower risk for in-hospital mortality (adjusted odds ratio: 0.46, 95% confidence interval: 0.30-0.70). Conclusions: Adherence to guideline-recommended preventive medications was associated with lower risk of in-hospital mortality in non-reperfused STEMI patients. The predictors of not receiving these medications need to be confirmed in future research.

The Difference in Accuracy Between Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score in Predicting In-Hospital Mortality of Acute ST-Elevation Myocardial Infarction Patients

“…Most patients (73%) who came to our hospital and underwent PCI are late presenters (> 12 h from onset). Only 15.7% of patients received reperfusion in ≤ 4 h. The proportion of patients who underwent reperfusion in our study is higher than in Dharma et al's study (65.6% versus 54%), albeit with a longer door to device time [24]. More patients (89%) underwent reperfusion in Luis et al's study with PCI (77%) and thrombolytic (11%) therapies while 60.9% patients in Chen et al's study underwent reperfusion with PCI (50.7%) and coronary artery bypass grafting (CABG) (10.2%).…”

“…Half of the patients received ACEi (58%) or beta-blocker (55.3%). Irawati et al mentioned that adherence to preventive drugs such as ASA, clopidogrel, anticoagulants and statins during treatment in non-reperfused STEMI patients can reduce mortality but the reasons for not receiving these drugs were not explained [ 24 ]. Patients with mortality outcome tend to be less likely to receive dual antiplatelet therapy, ACEi, beta-blockers and statins, whereas the provision of anticoagulants are not different in this study.…”