The use of different evidence-based medications and 5-year survival after an acute coronary syndrome: an observational study.

BACKGROUND

The use of different evidence-based medications (EBM medications) in-hospital survivors of acute coronary syndrome (ACS) may be associated with different long-term survival.

METHODS

In 1025 consecutive survivors receiving aspirin, we analysed the associations between statins (prescribed in 59.5%), beta-blockers (76.8%) and ACE-inhibitors/angiotensin receptor blockers (54.1%) and all-cause mortality up to 5 years as the endpoint, adjusting to the baseline risk using the GRACE hospital discharge risk score.

RESULTS

The use of beta-blockers and statins was associated with reduced mortality. Significant reduction was observed from 6 months for statins, and from 2 years for beta-blockers. Results were similar after further adjustment for concomitant use of other EBM medications. When interaction terms between different EBM medications were tested, the only significant interaction was between statins and beta-blockers (P=0.010). This interaction persisted (P=0.018) when the 1025 patients were sub-grouped regardless of the use of ACE-inhibitors/angiotensin receptor blockers. The use of beta-blockers was associated with reduced mortality for patients not discharged on statins (hazard ratio of 0.46, 95% C.I. 0.30-0.69), but this was not true for patients discharged on statins (hazard ratio of 1.19, 95% C.I. 0.62-2.30).

CONCLUSIONS

Different EBM medications after an ACS may be associated with different long-term survival and statins may be more important than others in patients already taking aspirin.