Optimal medical therapy for patients with acute myocardial infarction beyond one year after the initial attack = 급성심근경색 환자에서 발병 일년 경과 이후 적절한 약물치료에 대한 고찰

다국어 초록 (Multilingual Abstract)

Backgrounds and Purposes: Optimal medical therapy, including beta-blockers, inhibitors of renin-angiotensin system (RAS), and statins, is recommended in patients with acute myocardial infarction (AMI) in the absence of contraindications. However, the optimal duration of these medications has not been clearly demonstrated in the clinical studies. This observational study aimed to investigate the period during which these medications are associated with improved clinical outcomes.
Methods: Among patients enrolled in the Korea Acute Myocardial Infarction RegistryNational Institute of Health (KAMIR-NIH), in-hospital survivors who underwent echocardiographic evaluations were selected.
Results: In a Cox-proportional hazard analysis of 12,200 patients, beta-blockers (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.57-0.95; P=0.019), RAS inhibitors (HR 0.70; 95% CI 0.55-0.89; P=0.004), and statins at discharge (HR 0.65; 95% CI 0.48-0.87; P=0.004) were
all associated with lower 1-year cardiac mortality. At 1 year, 10,613 patients without all-cause death, MI, revascularization, re-hospitalization due to heart failure were selected for further analysis. RAS inhibitors (HR 0.53; 95% CI 0.37-0.76; P=0.001) and statins at 1 year (HR 0.30; 95% CI 0.14-0.61; P=0.001) were associated with lower 2-year cardiac mortality, whereas beta-blockers were not (HR 0.79; 95% CI 0.51-1.23; P=0.296). However, none of these medications—beta-blockers, RAS inhibitors, or statins—at 2 years were associated with reduced 3-year cardiac mortality among the 9,232 patients who remained event-free until then.
Conclusions: RAS inhibitors and statins were associated with reduced cardiac mortality for up to two years and beta-blockers for up to one year after the initial attack. The effectiveness of these medications beyond these periods remains questionable.

목차 (Table of Contents)

• CONTENTS
• ABSTRACT ……………………………………………………………….…...….... 5
• LIST OF ABBREVIATIONS ………………………………………….…... .....….... 6
• LIST OF TABLES …………………………………………..…………...…….…..... 8
• LIST OF FIGURES ……………………………………………..…………....……. 10
• I. INTRODUCTION …………………………………………..………….……...… 11
• II. METHODS ……………………………………………………..…….………… 13
• 1. Study population and data collection ………….………….………….……. 13
• 2. Clinical endpoints and definition ……………………………………...…... 14
• 3. Statistical analysis ……….………………………..………..…………...…. 14
• III. RESULTS ………………………….………………….…………………….…. 16
• 1. Baseline clinical characteristics ……………………..…………………….. 18
• 2. Clinical outcomes at 3 years ………………………………….………….... 30
• 3. Clinical outcomes at 1 year, from 1 to 2 years, and from 2 to 3 years …..… 38
• IV. DISCUSSION ……………………………………...……………………...…… 62
• V. REFERENCES …….…………………………………………...….…………..... 67
• VI. ABSTRACT IN KOREAN ……………………………………….…………..... 72