Long-term medication adherence in patients with ST-elevation myocardial infarction and primary percutaneous coronary intervention

• Published in: European journal of preventive cardiology 2015-07, Vol.22 (7), p.890-898
• Main Authors: Reuter, Hannes, Markhof, Anne, Scholz, Steffen, Wegmann, Christian, Seck, Catherine, Adler, Christoph, Michels, Guido, Hoepp, Hans-Wilhelm, Baldus, Stephan, Pfister, Roman
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; Chi-Square Distribution; Drug Prescriptions; Female; Germany; Humans; Logistic Models; Male; Medication Adherence; Middle Aged; Multivariate Analysis; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Prospective Studies; Registries; Risk Factors; Sex Factors; Time Factors; Treatment Outcome
• ISSN: 2047-4873; 2047-4881
• DOI: 10.1177/2047487314540385

Aims Besides early percutaneous coronary intervention (PCI) long-term medical treatment is crucial for outcomes after ST-elevation myocardial infarction (STEMI). The present study aimed to identify predictors of adherence to evidence-based medication in this high risk population. Methods and results A total of 1025 consecutive patients with adjudicated STEMI treated by primary PCI in a single centre as part of the Cologne Infarction Model (KIM) were prospectively analysed. Gender-specific multivariate predictors of long-term medication adherence were identified. Follow-up with available information on drug use was completed for 610 of 738 (82.7%) patients confirmed to be alive after a median period of 36 months. Adherence was persistently high for evidence-based medication with 90.8% for acetylsalicylic acid (ASA), 88.2% for statins, 87.5% for beta-blockers and 79.2% for ACE-inhibitors or angiotensin-receptor blockers (ARBs). Patients with a history of heart failure had a higher medication adherence to beta-blockers, ACE-inhibitors/ARBs and diuretics, whereas long-term prescription rates for calcium channel blockers (CCBs) were lower in patients with reduced versus preserved ejection fraction. Patients with a history of hypertension presented higher medication adherence to CCBs, ACE-inhibitors/ARBs and diuretics but not to beta-blockers. On multivariate analysis, age, body mass index (BMI), hypertension, chronic kidney disease and lack of PCI were independently associated with prescription of diuretics at follow-up. In women, adherence was lower to beta-blockers and higher to CCBs compared to men. Conclusion In the high risk population of STEMI patients long-term adherence to evidence-based medication is high. The lower adherence to beta-blockers and higher prescription rate for CCBs in women needs particular attention.