Author + information
There are limited data to evaluate the impact of optimal medical therapy (OMT) on patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents.
From national health insurance claims data in South Korea, 30,369 patients aged 18 years or older without known history of coronary artery disease, who underwent PCI with drug-eluting stents as a diagnosis of AMI between 2009 and 2013, were enrolled. OMT was defined as the combination of at least 1 anti-platelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. According to the discharge medication, patients were categorized into OMT (n=22,919) and non-OMT (n=7,450) groups. Clinical outcomes were compared in 2 groups.
The average age of study participants was 62.4±12.7 years and 22,585 (74.4 %) were men. During the follow-up period (median, 2.0 years; interquartile range, 0.9-3.2), OMT was associated with a significant reduction in death/myocardial infarction (hazard ratio, 0.838; 95% confidence interval, 0.755-0.929; P=0.001) and death/myocardial infarction/stroke (hazard ratio, 0.870; 95% confidence interval, 0.794-0.952; P=0.003). Additionally, even after adjustments with the propensity-score matching (n=14,896), the favorable pattern of death/ myocardial infarction (hazard ratio, 0.824; 95% confidence interval, 0.759-0.894; P<0.001) and death/myocardial infarction/stroke (hazard ratio, 0.869; 95% confidence interval, 0.810-0.933; P<0.001) was unchanged in the OMT group.
The use of OMT provided clinical benefits in South Korean patients with AMI undergoing PCI. Appropriate strategies to improve OMT use in AMI patients are needed in South Korea.