Drug Adherence and Long-Term Outcomes in Non-Revascularized Patients Following Acute Myocardial Infarction

This study examined long-term outcomes and adherence to guideline-based medications in non-revascularized acute myocardial infarction (MI) patients undergoing and not undergoing angiography. We analyzed non-revascularized MI patients hospitalized in Alberta, Canada between 2010-2016 and categorized them according to whether they had undergone coronary angiography. Adherence to guideline-based medications was determined by the proportion of days covered (PDC) and subdivided into categories based on PDC: 0% (none), 1-40% (low), 40-79% (intermediate) and >= 80% (high). Patients not undergoing angiography were older, less frequently male, and had more comorbidities. Those not receiving angiography had higher rates of 2-year myocardial infarction (9.9% vs 6.1%, p < 0.001), heart failure (14.9% vs 6.1%, p < 0.001), and mortality (29.4% vs 7.4%, p < 0.001). Optimal medial therapy (OMT), defined by high PDC for the combination of lipid-modifying agents, beta-blockers and angiotensin converting enzyme-inhibitors/receptor blockers (ACE-I/ARBs), was achieved in 32.9%. Patients not undergoing angiography had lower rates of OMT adherence (p<0.001). In patients not undergoing angiography, high-adherence to lipid-modifying agents (HR 0.70 [95% CI 0.57-0.87]), beta-blockers (HR 0.78 [0.62-0.97]), ACE-I/ARBs (HR 0.64 [0.52-0.79]) and OMT (HR 0.56 [0.40-0.77]) was independently associated with lower 2-year mortality. In conclusion, MI patients not receiving angiography had low adherence rates to guideline-based pharmacotherapies and high rates of long-term outcomes, suggesting potential treatment targets to improve prognosis in non-invasively managed MI patients. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

Non-revascularized MI patients who did not undergo angiography had low adherence rates to guideline-based medications and higher long-term risk, indicating potential areas for treatment improvement to enhance prognosis in non-invasively managed MI patients.