0048 : Adherence to guidelines for secondary prevention in patients with ST-segment elevation myocardial infarction: effect on 1-year mortality

Abstract

Several classes of medication improve survival in patient with ST-segment elevation myocardial infarction (STEMI). These classes have strong levels of recommendation in current guidelines; however, their efficacy when used according to the guidelines in the “real world” setting and in modern era with high levels of access to primary percutaneous coronary intervention is unclear. We sought to assess the effect of strict adherence to current international guidelines on 1-year all-cause mortality in a prospective cohort of patients with STEMI. Using data from the French RESCUe Network, we studied all patients with STEMI admitted and discharge alive from hospital between 2009 and 2013. Class I and II level guidelines were used to define the ‘optimal therapy’ (OT) group. The ‘undertreatment’ (UT) group comprised patients in whom at least one drug with a class I recommendation was missing. Multivariable Cox regression analysis propensity score for the prescription of OT was used. Of the 5161 patients discharged alive, 2991 (58%) were prescribed OT. The 1-year overall survival rate was 0.99 in the OT group (95% confidence interval [CI] 0.99-1.00) and 0.99 (95% CI 0.88-0.92) in the UT group. Patient characteristics in the UT group were worse than those in the OT group. Aand survival remained significant, with a hazard ratio of 0.12 (95% CI 0.07-0.22; p<0.001). Adherence to guidelines for secondary prevention therapy in patients with STEMI discharge alive from hospital independently and strongly associated with lower 1-year mortality. The author hereby declares no conflict of interest