Suboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: prescription rate, predictors, and prognostic value.

Only limited data are available for the recent trend of optimal evidence-based medical therapy at discharge after acute myocardial infarction (AMI) in Asia. We evaluated the predictors for the use of optimal evidence-based medical therapy at discharge and the association between discharge medications and 6-month mortality after AMI. Between November 2005 and January 2008, we evaluated the discharge medications among 9,294 post-MI survivors who did not have any documented contraindications to antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors (ACE-Is)/angiotensin II receptor blockers (ARBs), or statins in the Korea Acute Myocardial Infarction Registry. Optimal evidence-based medical therapy was defined as the use of all 4 indicated medications. Of these patients, 4,684 (50.4%) received all 4 medications at discharge. The discharge prescription rates of antiplatelet drugs, beta-blockers, ACE-Is/ARBs, and statins were 99.0%, 72.7%, 81.5%, and 77.2%, respectively. In multivariate analysis, advanced age, lower systolic blood pressure, higher Killip class at admission, left ventricular systolic dysfunction, higher blood creatinine level, lower total cholesterol levels, and coronary artery bypass grafting during hospitalization were independently associated with less use of optimal evidence-based medical therapy. In contrast, patients who underwent percutaneous coronary intervention were more likely to use optimal medications. In Cox proportional hazards model, optimal evidence-based medical therapy was an independent predictor of 6-month mortality after adjusting clinical characteristics and angiographic and procedural data. The optimal evidence-based medical therapy is prescribed at suboptimal rates, particularly in patients with high-risk features. New educational strategies are needed to increase the use of these secondary preventive medical therapies.

Lee JH ，Yang DH ，Park HS ，Cho Y ，Jeong MH ，Kim YJ ，Kim KS ，Hur SH ，Seong IW ，Hong TJ ，Cho MC ，Kim CJ ，Jun JE ，Park WH ，Chae SC ，Korea Acute Myocardial Infarction Registry Investigators ... -  《-》

Optimal medical therapy at discharge in patients with acute coronary syndromes: temporal changes, characteristics, and 1-year outcome.

Yan AT ，Yan RT ，Tan M ，Huynh T ，Soghrati K ，Brunner LJ ，DeYoung P ，Fitchett DH ，Langer A ，Goodman SG ，Canadian ACS Registries Investigators ... -  《-》

Association of early follow-up after acute myocardial infarction with higher rates of medication use.

Daugherty SL ，Ho PM ，Spertus JA ，Jones PG ，Bach RG ，Krumholz HM ，Peterson ED ，Rumsfeld JS ，Masoudi FA ... -  《ARCHIVES OF INTERNAL MEDICINE》

Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction.

Austin PC ，Tu JV ，Ko DT ，Alter DA ... -  《-》

The management of patients who have suffered an acute myocardial infarction in a tertiary care centre.

Haddad H ，Searles G ，Gillis A 《CANADIAN JOURNAL OF CARDIOLOGY》