Abstract
BackgroundMortality after ST-elevation myocardial infarction (STEMI) is dependent from best-medical treatment after initial event.ObjectivesDetermining the impact of prescription of guideline-recommended therapy after STEMI in two cohorts, patients with and without history of arterial hypertension, on survival.Methods1,025 patients of the Cologne Infarction Model registry with invasively adjudicated STEMI were dichotomized according to their history of arterial hypertension. We recorded prescription rates and dosing of RAS-inhibitors, β-blockers and statins in all patients. The primary outcome was all-cause death. Mean follow-up was 2.5 years.ResultsMean age was 64 ± 13 years, 246 (25%) were women. 749 (76%) patients had a history of hypertension. All-cause mortality was 24.2%, 30-day and 1-year mortality was 11.3% and 16.6%, respectively. History of hypertension correlated with lower mortality (hazard ratio [HR], @30 days: 0.41 [0.27-0.62], @1 year: 0.37 [0.26-0.53]). After adjusting for age, sex, Killip-class, diabetes mellitus, body-mass index, kidney function and statin prescription at discharge 1-year mortality HR was 0.24 (0.12-0.48). At discharge, prescription rates for RAS-inhibitors, β-blockers and statins, as well as individual dosing and long-term persistence of RAS-inhibitors were higher in patients with history of hypertension. On the same lines, prescription rates for RAS-inhibitors, β-blockers and statins at discharge correlated significantly with lower mortality regardless of history of hypertension.ConclusionPatients with history of hypertension show higher penetration of guideline recommended drug therapy after STEMI, which may contribute to better survival. Better tolerance of β-blockers and RAS-inhibitors in patients with history of hypertension, not hypertension itself, likely explains these differences in prescription and dosing.
Highlights
The broader availability of cardiac catheterization laboratories, shorter transfer times for percutaneous coronary interventions and modern drug therapy with proven prognostic benefit in primary and secondary prevention are major achievements in the treatment of acute ST-elevation myocardial infarction (STEMI)
History of arterial hypertension at hospital admission significantly correlated with overall survival (HR for mortality 0.37, 95% confidence interval [Confidence interval (CI)] 0.27-0.51, p < 0.001, Figure 2A)
Our findings show that even in a cohort of STEMI patients triaged for a primary percutaneous coronary intervention strategy with minimal system delay the prescription rate of medication for secondary prevention at discharge correlates with short- and long-term prognosis
Summary
The broader availability of cardiac catheterization laboratories, shorter transfer times for percutaneous coronary interventions and modern drug therapy with proven prognostic benefit in primary and secondary prevention are major achievements in the treatment of acute ST-elevation myocardial infarction (STEMI). Due to these measures the incidence of STEMI and the overall mortality due to ischemic heart disease has decreased in Europe and the United States in recent years [1, 2]. Mortality after ST-elevation myocardial infarction (STEMI) is dependent from best-medical treatment after initial event
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