Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea.
Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea.
J Am Heart Assoc. 2023 May 16;12(10):e024370. doi: 10.1161/JAHA.121.024370. Epub 2023 May 9.
Background The secondary prevention with pharmacologic therapy is essential for preventing recurrent cardiovascular events in patients experiencing acute myocardial infarction. Guideline-based optimal medical therapy (OMT) for patients with acute myocardial infarction consists of antiplatelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, β-blockers, and statins. We aimed to determine the prescription rate of OMT use at discharge and to evaluate the impact of OMT on long-term clinical outcomes in patients with acute myocardial infarction who underwent percutaneous coronary intervention in the drug-eluting stent era using nationwide cohort data. Methods and Results Using the National Health Insurance claims data in South Korea, patients with acute myocardial infarction who had undergone percutaneous coronary intervention with a drug-eluting stent between July 2013 and June 2017 were enrolled. A total of 35 972 patients were classified into the OMT and non-OMT groups according to the post-percutaneous coronary intervention discharge medication. The primary end point was all-cause death, and the 2 groups were compared using a propensity-score matching analysis. Fifty-seven percent of patients were prescribed OMT at discharge. During the follow-up period (median, 2.0 years [interquartile range, 1.1-3.2 years]), OMT was associated with a significant reduction in the all-cause mortality (adjusted hazard ratio [aHR], 0.82 [95% CI, 0.76-0.90]; <0.001) and composite outcome of death or coronary revascularization (aHR, 0.89 [95% CI, 0.85-0.93]; <0.001). Conclusions OMT was prescribed at suboptimal rates in South Korea. However, our nationwide cohort study showed that OMT has a benefit for long-term clinical outcomes on all-cause mortality and composite outcome of death or coronary revascularization after percutaneous coronary intervention in the drug-eluting stent era.
对于经历急性心肌梗死的患者，药物治疗的二级预防对于预防心血管事件的再次发生至关重要。急性心肌梗死患者的基于指南的最佳药物治疗（OMT）包括抗血小板治疗、血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂、β受体阻滞剂和他汀类药物。我们旨在通过全国性队列数据确定药物洗脱支架时代经皮冠状动脉介入治疗的急性心肌梗死患者出院时 OMT 的使用处方率，并评估 OMT 对长期临床结局的影响。
利用韩国国家健康保险索赔数据，纳入了 2013 年 7 月至 2017 年 6 月期间接受药物洗脱支架经皮冠状动脉介入治疗的急性心肌梗死患者。根据经皮冠状动脉介入治疗出院后的药物治疗，将 35972 例患者分为 OMT 和非 OMT 组。主要终点是全因死亡，并用倾向评分匹配分析比较两组。出院时，57%的患者接受了 OMT。在随访期间（中位数 2.0 年[四分位距 1.1-3.2 年]），OMT 显著降低了全因死亡率（调整后的危险比[aHR]，0.82[95%CI，0.76-0.90]；<0.001）和死亡或冠状动脉血运重建的复合结局（aHR，0.89[95%CI，0.85-0.93]；<0.001）。
韩国的 OMT 处方率不理想。然而，我们的全国性队列研究表明，在药物洗脱支架时代，经皮冠状动脉介入治疗后，OMT 对全因死亡率和死亡或冠状动脉血运重建的复合结局具有长期临床获益。
