|Title||Medication, reperfusion therapy and survival in a community-based setting of hospitalised myocardial infarction.|
|Publication Type||Journal Article|
|Year of Publication||2013|
|Authors||O'Brien EC, Rose KM, Suchindran CM, Sturmer T, Chang PP, Chambless L, Guild CS, Rosamond WD|
|Date Published||2013 Jun|
|Keywords||Adult, Aged, Cause of Death, Female, Follow-Up Studies, Humans, Inpatients, Male, Middle Aged, Myocardial Infarction, Myocardial Reperfusion, Platelet Aggregation Inhibitors, Population Surveillance, Retrospective Studies, Stents, Survival Rate, Tissue Plasminogen Activator, Treatment Outcome, United States|
OBJECTIVE: To examine the survival benefit of multiple medical therapies in a large, community-based population of validated myocardial infarction (MI) events.
DESIGN: Retrospective observational cohort study.
SETTING: Population-based sample of 30 986 definite or probable MIs in residents of four US communities aged 35-74 years randomly sampled between 1987 and 2008 as part of the Atherosclerosis Risk in Communities Surveillance Study.
MAIN OUTCOME MEASURES: All-cause mortality 30, 90 and 365 days after discharge.
RESULTS: We used unadjusted and propensity score (PS) adjusted models to examine the relationship between medical therapy use and mortality. In unadjusted models, each medication and procedure was inversely associated with 30-day mortality. After PS adjustment, the crude survival benefits were attenuated for all therapies except for intravenous tissue plasminogen activator therapy (IV-tPA) and stent use. After inclusion of other therapies received during the event in regression models, risk ratio effect estimates (RR; (95% CI)) were attenuated for aspirin (0.66; (0.58 to 0.76) to 0.91 (0.80 to 1.03)), non-aspirin antiplatelets (0.74; (0.59 to 0.92) to 0.92 (0.72 to 1.18)), IV-tPA (0.50; (0.41 to 0.62) to 0.65 (0.52 to 0.80)) and stents (0.53 (0.40 to 0.69) to 0.68 (0.49 to 0.94)). Effect estimates remained stable for all other therapies and were similar for 90- and 365-day mortality endpoints.
CONCLUSIONS: We observed inverse associations between receipt of six medications and procedures for MI and all-cause mortality at 30, 90 and 365 days after adjustment for PS. The mortality benefits observed in this population-based setting are consistent with those reported in clinical trials.
|PubMed Central ID||PMC4118665|
|Grant List||HHSN268201100012C / HL / NHLBI NIH HHS / United States |
HHSN268201100009I / HL / NHLBI NIH HHS / United States
268201100011C / / PHS HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
268201100005C / / PHS HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
268201100007C / / PHS HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
268201100012C / / PHS HHS / United States
268201100008C / / PHS HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
268201100009C / / PHS HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
268201100006C / / PHS HHS / United States
268201100010C / / PHS HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States