Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Dec 1;84(12):1084-1091. doi: 10.1097/JCMA.0000000000000621.
Statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guidelines as secondary prevention medications to improve the long-term outcomes of post-acute myocardial infarction (AMI) patients. However, adequate drug adherence has always been challenging, and different treatment regimens may lead to divergent outcomes that remain unclear under current myocardial infarction (MI) care standards. This study investigated the association between use of different preventive regimens post-AMI and patients' long-term outcomes.
This cohort study used data files from the Taiwan National Health Insurance Research Database. A total of 77 520 people who were hospitalized with AMI between 2002 and 2015 were assessed. On the basis of medication possession ratio (MPR) to individual medications, eight treatment groups were examined in this study. Receiving therapy was defined as MPR ≥40%. We investigated the association between different treatment groups and all-cause mortality in 24 months.
Overall, 51 322 patients with ST-elevation MI and 26 198 with non-ST-elevation MI were included in the study. Patients received all three preventive medications show the lowest mortality in 24 months follow-up periods among all treatment groups. Patients who did not usage of any of these three preventive medications had the highest mortality in 24 months (adjusted hazard ratio, 1.78; 95% CI, 1.64-1.93). This mortality rate had the same pattern across the three cohort generations (2002-2005, 2006-2010, and 2011-2015).
In this large population-based real-world study, usage of three preventive therapies post-MI was associated with the lowest rate of all-cause mortality.
他汀类药物、β受体阻滞剂和血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂已被指南推荐为二级预防药物，以改善急性心肌梗死后（AMI）患者的长期预后。然而，药物的充分依从性一直是一个挑战，不同的治疗方案可能会导致目前心肌梗死（MI）治疗标准下尚不清楚的不同结果。本研究探讨了 AMI 后不同预防方案的使用与患者长期预后之间的关系。
本队列研究使用了来自台湾全民健康保险研究数据库的数据文件。共评估了 2002 年至 2015 年间因 AMI 住院的 77520 人。基于个体药物的药物暴露率（MPR），本研究共检查了 8 个治疗组。接受治疗定义为 MPR≥40%。我们调查了不同治疗组与 24 个月全因死亡率之间的关系。
总体而言，51322 例 ST 段抬高型心肌梗死患者和 26198 例非 ST 段抬高型心肌梗死患者纳入研究。在所有治疗组中，接受三种预防药物治疗的患者在 24 个月的随访期间死亡率最低。未使用这三种预防药物中的任何一种的患者在 24 个月时死亡率最高（调整后的危险比，1.78；95%CI，1.64-1.93）。这种死亡率在三个队列世代（2002-2005、2006-2010 和 2011-2015）中都有相同的模式。
在这项大型基于人群的真实世界研究中，AMI 后使用三种预防疗法与全因死亡率最低相关。
