Physicians' Academy for Cardiovascular Education

Suboptimal medical therapy for ACS patients is associated with increased mortality

Trends in Optimal Medical Therapy Prescription and Mortality After Admission for Acute Coronary Syndrome: a 9-Year Experience in a Real-World Setting

Literature - Hoedemaker NPG, Damman P, Ottervanger JP, et al. - Eur Heart J - CV Pharmacotherapy 2018


European Society of Cardiology (ESC) guidelines for the treatment of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) recommend the use of aspirin, P2Y12 inhibitors, and statins in all patients with these conditions, as well as beta-blockers, and angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) in those with additional left ventricular systolic dysfunction (LVSD) or heart failure (HF) [1,2].

In this study, the association between prescription of medical therapy in acute coronary syndrome patients and mortality was assessed in a Dutch tertiary hospital. All consecutive STEMI and NSTEMI patients from 2006 until 2014 were included in the analysis. The main prescription measures were optimal medical therapy (OMT) prescription, defined as the combination of aspirin, P2Y12 inhibitor, statin, beta-blocker, and ACEi/ARB, and prescription (APS) of at least aspirin, P2Y12 inhibitors and a statin at discharge, 30 days, and 1 year. The endpoints were all-cause death and cardiac mortality.

Main results


In a single-center observational study, less than 50% of acute coronary syndrome patients were on aspirin, P2Y12 inhibitor, statin, beta-blocker, and ACEi/ARB at discharge. The prescription of these recommended therapies at discharge was associated with a reduction in 1-year mortality.


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Find this article online at Eur Heart J - CV Pharmacotherapy

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