Abstract 17908: Evidence-Based Cardiovascular Preventive Medications are Infrequently Utilized in Patients Presenting with ST-Elevation Myocardial Infarction
Introduction: The decreasing incidence of STEMI due to acute coronary thrombosis is at least partially related to increased use of primary and secondary prevention (in particular, antiplatelet and statins). Still, nearly 400,000 Americans present each year with STEMI. We hypothesized that use of evidenced-based preventive therapy in patients presenting with STEMI would be sub-optimal.
Methods: As part of the Minneapolis Heart Institute “Level 1 MI” program, preadmission medications in patients admitted with STEMI were recorded using each patient's electronic medical record. The percentage of patients treated with aspirin, statins, and ACE-inhibitors was assessed in patients with and without previously diagnosed coronary artery disease (CAD).
Results: From May 1, 2007 to March 1, 2010, 1,186 consecutive patients with documented STEMI were enrolled in the Level 1 MI program. Medications were unable to be verified in 11 patients, leaving 1,175 evaluable patients. The rates of cardiac risk factors and use of preventive medication in patients with (n=358) and without (n=816) known CAD is shown in Table 1.
Conclusion: Despite a high frequency of cardiac risk factors, patients without known CAD presenting with STEMI were rarely on primary prevention medications. Potential reasons include absence of indications for primary prevention by current guidelines, no previous medical care, inadequate risk factor identification and modification or non-compliance. Efforts aimed at detecting early cardiovascular disease and better compliance with appropriate preventive cardiovascular medications may, if successful, produce even further reductions in cardiovascular morbidity and mortality. In addition, the use of secondary prevention medication in patients with known CAD was significantly lower than expected.
- © 2010 by American Heart Association, Inc.