Determinants of Insufficient Optimal Medical Therapy after Acute Myocardial Infarction

Abstract

Objective Although the importance of evidence-based optimal medical therapy (OMT) after acute myocardial infarction (AMI) has been recognized, the prescription rate of OMT is not sufficiently high in real-word clinical settings. The purpose of this study was to identify the clinical characteristics of AMI patients who did not receive OMT. Methods The present study was a retrospective study. OMT was defined as the combination of antiplatelet therapy, angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), betablockers, and statins at the time of hospital discharge. Non-OMT was defined as the lack of either antiplatelet therapy, ACE inhibitors/ARBs, beta-blockers, or statins. Results A total of 457 AMI patients were included as the final study population, and 98 patients (22.4%) lacked at least 1 OMT medication. The prescription rates of antiplatelet therapy, ACE inhibitors/ARBs, betablockers, and statins were 98.7%, 87.5%, 90.4%, and 96.7%, respectively. In the multivariate logistic regression analysis, age (per 1-year increase: odds ratio [OR] 1.033, 95% confidence interval [CI] 1.007-1.059, p= 0.014), hemodialysis (vs. no hemodialysis: OR 2.707, 95% CI 1.082-6.774, p=0.033), estimated glomerular filtration rate <30 mL/min/1.73 m 2 without hemodialysis (OR 4.585, 95% CI 1.975-10.644, p<0.001), AMI caused by vasospastic angina [VSA] (vs. no VSA: OR 13.198, 95% CI 1.809-96.260, p=0.011), and asthma (vs. no asthma: OR 7.241, 95% CI 1.716-30.559, p=0.007) were significantly associated with non-OMT, whereas heart rate on admission (per 1-bpm increase: 0.987, 95% CI 0.975-0.999, p=0.033), any PCI (vs. no PCI: OR 0.156, 95% CI 0.066-0.373, p<0.001), and ST-elevation myocardial infarction [STEMI] (vs. NSTEMI: OR 0.384, 95% CI 0.218-0.675, p=0.001) were inversely associated with non-OMT. Conclusion An advanced age, VSA, bradycardia, asthma, impaired renal function, non-PCI revascularization, and non-ST-elevation myocardial infarction were significantly associated with non-OMT.

Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke

“…They demonstrated advanced age, impaired renal function, vasospastic angina, bradycardia, asthma, non-PCI revascularization, and NSTEMI that were significantly associated with non-OMT. 11 Yan et al examined the use of medications at discharge among 5833 patients from the Canadian ACS I and ACS II Registries. Advanced age, female sex, prior heart failure, renal function, and coronary bypass surgery were shown to be negative independent predictors of OMT.…”

How to Increase the Rate of Optimal Medical Therapy following Acute Myocardial Infarction

“…To the Editor Haraguchi et al showed that several baseline characteristics were associated with the failure of optimal medical therapy, including anti-platelets, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, and statins, at the time of index discharge following acute myocardial infarction ( 1 ). Their findings may help improve the strategy for increasing the rate of delivering optimal medical therapy following acute myocardial infarction.…”

Authors' Reply: How to Increase the Rate of Optimal Medical Therapy following Acute Myocardial Infarction

“…The Authors Reply We appreciate the constructive comments made by Dr. Imamura regarding our manuscript (1). First, we did not exclude patients with acute myocardial infarction (AMI) caused by vasospastic angina from our study population.…”