Clinical Research in Cardiology

, Volume 103, Issue 8, pp 655–664

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

  • Ute Amann
  • Inge Kirchberger
  • Margit Heier
  • Hildegard Golüke
  • Wolfgang von Scheidt
  • Bernhard Kuch
  • Annette Peters
  • Christa Meisinger
Original Paper

DOI: 10.1007/s00392-014-0688-0

Cite this article as:
Amann, U., Kirchberger, I., Heier, M. et al. Clin Res Cardiol (2014) 103: 655. doi:10.1007/s00392-014-0688-0

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.

Keywords

Acute myocardial infarctionMortalitySecondary prevention drug therapyDrug combination

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ute Amann
    • 1
    • 2
  • Inge Kirchberger
    • 1
    • 2
  • Margit Heier
    • 1
    • 2
  • Hildegard Golüke
    • 2
  • Wolfgang von Scheidt
    • 3
  • Bernhard Kuch
    • 3
    • 4
  • Annette Peters
    • 2
  • Christa Meisinger
    • 1
    • 2
  1. 1.MONICA/KORA Myocardial Infarction RegistryCentral Hospital of AugsburgAugsburgGermany
  2. 2.Institute of Epidemiology IIHelmholtz Zentrum München, German Research Center for Environmental Health (GmbH)NeuherbergGermany
  3. 3.Department of Internal Medicine I, CardiologyCentral Hospital of AugsburgAugsburgGermany
  4. 4.Department of Internal Medicine/CardiologyHospital of NördlingenNördlingenGermany