Determinants of Insufficient Optimal Medical Therapy after Acute Myocardial Infarction

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...

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Published in:Internal Medicine 2020/06/15, Vol.59(12), pp.1489-1495
Main Authors: Haraguchi, Yumiko, Sakakura, Kenichi, Yamamoto, Kei, Taniguchi, Yousuke, Tsukui, Takunori, Seguchi, Masaru, Wada, Hiroshi, Momomura, Shin-ichi, Fujita, Hideo
Format: Article
Language:English
Subjects:
acute myocardial infarction
Angina
Angiotensin II
angiotensin II receptor blockers
Angiotensin-converting enzyme inhibitors
Asthma
Beta blockers
Bradycardia
Glomerular filtration rate
Heart attacks
Heart rate
Hemodialysis
Internal medicine
Myocardial infarction
optimal medical therapy
Original
Patients
Peptidyl-dipeptidase A
Population studies
Renal function
Statins
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Summary: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), beta-blockers, 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, beta-blockers, 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
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.4016-19