Abstract P202: Long-Term Outcomes and Use of Combination Evidence-Based Medical Therapy After Acute Coronary Syndromes

Abstract

Background: Several medications have been shown to reduce mortality in patients with acute coronary syndrome (ACS); however long-term outcomes related to use of combinations of these medications is limited. Methods: Data on demographics, comorbidities and ACS management from 2,687 consecutive patients admitted with ACS between January 1999 and March 2006 were included. A composite appropriateness score (number of drugs received/number of drugs indicated) was created for discharge use of evidence-based medications (EBMs) including anti-platelet agents, beta-blockers, ACE-inhibitors and statins. Multivariate models were used to examine the impact of EBM score on two-year mortality with adjustment for the components of the Global Registry of Acute Coronary Events (GRACE) risk score and gender. Results: A total of 216 patients died during follow-up. Women were older, had more comorbidities, and were less likely to receive all 4 EBMs (69.5% vs. 77.8%, p < 0.001) than men. Patients who received all 4 EBMs (appropriateness score IV) were more likely to be alive at two years compared to patients who received < 1 EBM (OR 0.29, 95% CI, 0.17 - 0.49). When men and women were examined separately, a similar pattern was observed (OR 0.30, 95% CI 0.14 - 0.63 for men, and OR 0.28, 95% CI 0.13 - 0.61 for women) for those receiving all 4 EBMs at discharge compared to those who received < 1 EBM. Conclusions: Receipt of combination EBMs after ACS is significantly associated with decreased long-term mortality among both men and women.