Effect of evidence-based cardiac drug therapy on mortality in patients with acute coronary syndrome: Findings from the Gulf COAST registry.

Abstract

To evaluate the prevalence and impact of the prescribing of an evidence-based cardiac medication (EBM) combination on 1-month, 6-months, and 12-months all-cause mortality in patients with acute coronary syndrome (ACS). Data were analyzed from 3681 consecutive patients diagnosed with ACS admitted to 29 hospitals in 4 Middle Eastern countries from January 2012 to January 2013. The EBM combination consisted of concurrent prescribing of an antiplatelet therapy, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), β-blocker, and a statin, at hospital discharge. Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 60±13years, 66% (n=2436) were males. In all, 69% (n=2542) of the patients received the quadruple EBM combination at discharge. Two-way interactions between EBM and age (P=0.824), EBM and GRACE risk score (P=0.873) and between EBM and discharge diagnosis (P=0.836) were all not statistically significant. Adjusting for demographic and clinical characteristics, the prescribing of EBM combination was associated with significantly lower cumulative all-cause mortality at 1-month (adjusted OR (aOR), 0.43; 95% confidence interval (CI): 0.24-0.79; P=0.007), which persisted at 6-months (aOR, 0.52; 95% CI: 0.38-0.72; P<0.001) and at 12-months of follow-up (aOR, 0.58; 95% CI: 0.44-0.75; P<0.001) posthospital discharge. Among patients discharged after an ACS event, concurrent EBM prescribing was associated with lower all-cause mortality that persists for up to 12-months posthospital discharge. The relative benefits of EBMs were also consistent across age, GRACE risk score, and discharge diagnosis.