Trends in Optimal Medical Therapy Prescription and Mortality After Admission for Acute Coronary Syndrome: a 9-Year Experience in a Real-World Setting

Optimal medical therapy (OMT) is recommended in acute coronary syndrome (ACS) patients. Few studies present temporal trends of OMT prescription and its impact on outcomes in a real-world setting. We aimed to evaluate OMT prescription in a real-world ACS population and its relation to mortality during almost a decade. Consecutive STEMI and NSTEMI patients (n = 9202) admitted to a single Dutch tertiary hospital between 2006-2014 were included and followed for drug prescription and mortality up to 1 year. OMT was defined as prescription of aspirin, P2Y12inhibitors, statin, beta-blockers, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARB). OMT prescription was 43.7% at discharge, 46.6% at 30-days, and 25.5% at 1-year. OMT prescription at discharge was lower among NSTEMI patients (34.5% vs. 49.2%, p  < 0.001). OMT prescription at discharge, 30-days and 1-year and mortality outcomes did not change during the study period. After adjustment for baseline and admission characteristics, OMT at discharge was associated with a reduction in mortality in patients who survived hospitalisation for the index event [adjusted hazard ratio: 0.66, 95% confidence interval (0.46-0.93)]. In this single-centre observational registry with >9000 patients reflecting almost a decade of ACS care, <50% of patients were on OMT at discharge. Prescription of OMT and mortality outcomes remained stable during the study period. After adjustment, OMT prescription at discharge was associated with reduced mortality in ACS survivors. Further contemporary randomised studies are warranted to determine the role of beta-blockers and ACEi/ARBs in ACS patients with preserved LVEF