Medication, reperfusion therapy and survival in a community-based setting of hospitalised myocardial infarction.

TitleMedication, reperfusion therapy and survival in a community-based setting of hospitalised myocardial infarction.
Publication TypeJournal Article
Year of Publication2013
AuthorsO'Brien EC, Rose KM, Suchindran CM, Sturmer T, Chang PP, Chambless LE, Guild CS, Rosamond WD
JournalHeart
Volume99
Issue11
Pagination767-73
Date Published2013 Jun
ISSN1468-201X
KeywordsAdult, 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
Abstract

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.

INTERVENTIONS: None.

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.

DOI10.1136/heartjnl-2012-303244
Alternate JournalHeart
PubMed ID23456567
PubMed Central IDPMC4118665
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
268201100011C / / PHS 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
HHSN268201100007C / HL / NHLBI NIH HHS / United States
268201100012C / / PHS HHS / United States
268201100008C / / PHS HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100006C / 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