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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

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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.

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Acknowledgments

The KORA research platform and the MONICA Augsburg studies were initiated and financed by the Helmholtz Zentrum München, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education, Science, Research and Technology and by the State of Bavaria. Since the year 2000, the collection of MI data has been co-financed by the German Federal Ministry of Health to provide population-based MI morbidity data for the official German Health Report (see www.gbe-bund.de). Steering partners of the MONICA/KORA Infarction Registry, Augsburg, include the KORA research platform, Helmholtz Zentrum München and the Department of Internal Medicine I, Cardiology, Central Hospital of Augsburg. We thank all members of the Helmholtz Zentrum München, Institute of Epidemiology II and the field staff in Augsburg who were involved in the planning and conduct of the study. We wish to thank the local health departments, the office-based physicians and the clinicians of the hospitals within the study area for their support. Finally, we express our appreciation to all study participants.

Conflict of interest

No conflict of interest to declare.

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Authors and Affiliations

  1. MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany

    Ute Amann, Inge Kirchberger, Margit Heier & Christa Meisinger

  2. Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany

    Ute Amann, Inge Kirchberger, Margit Heier, Hildegard Golüke, Annette Peters & Christa Meisinger

  3. Department of Internal Medicine I, Cardiology, Central Hospital of Augsburg, Augsburg, Germany

    Wolfgang von Scheidt & Bernhard Kuch

  4. Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany

    Bernhard Kuch

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  1. Ute Amann
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Correspondence to Ute Amann.

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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 103, 655–664 (2014). https://doi.org/10.1007/s00392-014-0688-0

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