P3642Use of optimal medical therapy in acute coronary syndrome patients with a previous history of cardiovascular disease

Abstract

Background/Introduction: Acute coronary syndrome (ACS) is a common manifestation of cardiovascular disease (CVD). Use of optimal medical therapy (OMT) can improve outcomes of ACS and are recommended by international guidelines. Yet, data on the use of OMT in patients with a previous history of CVD in a realworld setting is sparse. Purpose: We aimed to assess the use OMT in ACS patients and a history of CVD in a real‐world setting and study the relation between the use of OMT and in‐hospital and 30‐day outcomes. Methods: We used a single‐centre prospective observational registry of patients with STEMI or NSTEMI admitted between 2006‐2014. We analysed baseline differences between patients with a history of a CVD (previous myocardial infarction, stroke, percutaneous coronary intervention or coronary bypass grafting) and those who did not. Subsequently, we selected patients with previous CVD and compared patients with or without OMT before admission. OMT was defined as the use of aspirin, statin, beta‐blocker and ACE‐inhibitor or ATII blocker. Main outcomes were in‐hospital and 30‐day death. We used a multivariate regression analysis to adjust for the non‐randomised nature of the comparison. Results: Medical history was available for 8873 ACS patients, 1690 patients with a history CVD and 6903 without CVD. Information on OMT was available for 1606/1690 (95%) patients with a history of CVD, OMT before admission was used by 30.5% in the CVD group and 2.8% in the Non‐CVD group (p<0.001). Patients with OMT before admission were younger (69.9 (SD 10.9) vs. 72.0 (SD 11.3) years, p<0.001) and had significantly higher rates of cardiovascular risk factors. Patients with OMT before admission had higher rates of OMT at discharge (72.5% vs. 43.2%, p<0.001). Patients with OMT before admission had significantly lower rates of in‐hospital (3.3% vs. 5.9%, p<0.05) and 30‐day mortality (4.1% vs. 7.7%, p<0.01). Patients with OMT at discharge had lower rates of 30‐day mortality (0.3% vs. 7.6%, p<0.01). After adjustment for independent predictors for mortality, not using OMT at discharge was associated with death at 30‐days (OR 28.33 (95% Confidential Interval 6.69‐119.93), p<0.001). Conclusion(s): This registry‐based study showed that in ACS patients with a history of CVD, only 30% used OMT at the moment of the acute (second) event. The use of OMT before admission and at discharge was independently associated with lower in‐hospital and 30‐day death rates.