Abstract 1514: Effect of Prior Medication on Clinical Characteristics and Hospital Outcome of Acute Coronary Syndromes
Background: Patients (Pts) with acute coronary syndrome (ACS) are often on medication at time of admission, because of risk factors and/or prior history of cardiovascular disease. We assessed the influence of prior medication on mode of presentation and prognosis of ACS.
Methods: We studied 18,400 Pts included in a nationwide prospective registry of ACS and determined the influence of prior medication with aspirin (ASA), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEI), and statins (Stat) on type of ACS and its effect on all-cause hospital mortality.
Results: ACS presentation was more benign in Pts previously medicated with ASA, BB, ACEI or Stat (Table⇓). Pts on prior medication with these drugs were older, more often female, less often smokers, and more often presented BMI >=25, diabetes, hypertension, hypercholesterolemia, and prior history of cerebrovascular or peripheral arterial disease, MI or myocardial revascularization. Of the 3453 Pts with prior MI, 63.9% were on ASA, 42.0% BB, 47.6% ACEI, and 49.4% Stat. Of the 2946 diabetics, 29.6% were on ASA, 32.5% ACEI, and 25.7% Stat. Of the 1275 Pts with prior stroke/TIA, 36.3% were on ASA and 24.2% Stat. Of the 382 Pts with peripheral arterial disease, 38.8% were on ASA and 33.7% Stat. Overall, 344 (3.4%) of the 9980 non-ST-elevation ACS and 703 (8.3%) of the 8420 ST-elevation MI Pts died. Prior BB was an independent predictor of hospital mortality in non-ST-elevation ACS (adjusted OR = 1.58; 95% CI, 1.09–2.29; p=0.016), but not ST-elevation MI. Prior medication with ASA, an ACEI or a Stat did not influence outcome of either type of ACS.
Conclusions: In the real world, Pts at high risk for atherothrombotic disease are insufficiently medicated with ASA, BB, ACEI and/or Stat. Prior medication with these drugs is associated with a more benign clinical presentation of ACS. Further studies are required to clarify the mechanisms conferring increased hospital mortality in Pts with non-ST-elevation ACS admitted on a BB.