Abstract 18453: Long-Term Medication Adherence and Prognosis After Successful Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: Experiences from the Korean Multicenter Registry
Introduction: Although evidence-based optimal medical therapy (OMT) is essential for prognosis in patients with acute myocardial infarction (AMI), many patients discontinue OMT after AMI.
Hypothesis: We aimed to investigate the long-term continuation rate of OMT and prognosis in patients with AMI who underwent successful percutaneous coronary intervention (PCI) with coronary stents using the Korean multicenter registry.
Methods: Among 4,748 patients in the COnvergent REgistry of cAtholic and chonnAm university for Acute MI (COREA-AMI) from 2004 to 2009, we enrolled 4,546 surviving patients at discharge after AMI. We analyzed the continuation rate of OMT at discharge, 1-year and 2-year after discharge. We also compared the incidence of all-cause death, cardiac death, non-fatal MI, and any revascularization from 2-years after AMI between patients who received all OMT medications at 2-year and those who did not receive all OMT medications at 2-year.
Results: Median follow-up duration was 1,295 days (interquartile range [881-1799]). At discharge time, prescription rate was 99.4% for antiplatelet medications, 77.7% for beta-blocker, 83.1% for ACEi or ARB, and 84.2% for statin. One-year continuation rate was 99.0% for antiplatelet medications, 70.3% for beta-blocker, 76.4% for ACEi or ARB, and 85.9% for statin. Two-year continuation rate was 98.5% for antiplatelet medications, 67.2% for beta-blocker, 74.8% for ACEi or ARB, and 85.5% for statin. Patients who received all OMT at 2-year follow-up showed lower incidence of all-cause mortality (hazard ratio [HR] 0.63, 95% CI 0.46-0.85, p = 0.003), cardiac mortality (HR 0.47, 95% CI 0.27-0.80, p = 0.006), and nonfatal MI (HR 0.60, 95% CI 0.39-0.94, p = 0.025) from 2-years after initial AMI compared to those who did not receive all OMT at 2-years follow-up. There was no significant difference for the incidence of repeat revascularization between 2 groups (HR 1.00, 95% CI 0.85-1.18, p = 0.987).
Conclusions: Adherence rate for OMT, especially beta-blocker and ACEi or ARB, in surviving AMI patients declined over time in the Korean multicenter data. Because OMT underuse was associated with worse clinical outcomes, physicians should carefully educated AMI patients in medication adherence.
Author Disclosures: Y. Ahn: None. M. Kim: None. J. Kim: None. D. Sim: None. Y. Hong: None. J. Kim: None. M. Jeong: None. J. Cho: None. J. Park: None. K. Seung: None. K. Chang: None.
- © 2016 by American Heart Association, Inc.