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

Publication ,  Journal Article
O'Brien, EC; Rose, KM; Suchindran, CM; Stürmer, T; Chang, PP; Chambless, L; Guild, CS; Rosamond, WD
Published in: Heart
June 2013

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.

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Published In

Heart

DOI

EISSN

1468-201X

Publication Date

June 2013

Volume

99

Issue

11

Start / End Page

767 / 773

Location

England

Related Subject Headings

  • United States
  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Survival Rate
  • Stents
  • Retrospective Studies
  • Population Surveillance
  • Platelet Aggregation Inhibitors
  • Myocardial Reperfusion
  • Myocardial Infarction
 

Citation

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ICMJE
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O’Brien, E. C., Rose, K. M., Suchindran, C. M., Stürmer, T., Chang, P. P., Chambless, L., … Rosamond, W. D. (2013). Medication, reperfusion therapy and survival in a community-based setting of hospitalised myocardial infarction. Heart, 99(11), 767–773. https://doi.org/10.1136/heartjnl-2012-303244
O’Brien, Emily C., Kathryn M. Rose, Chirayath M. Suchindran, Til Stürmer, Patricia P. Chang, Lloyd Chambless, Cameron S. Guild, and Wayne D. Rosamond. “Medication, reperfusion therapy and survival in a community-based setting of hospitalised myocardial infarction.Heart 99, no. 11 (June 2013): 767–73. https://doi.org/10.1136/heartjnl-2012-303244.
O’Brien EC, Rose KM, Suchindran CM, Stürmer T, Chang PP, Chambless L, et al. Medication, reperfusion therapy and survival in a community-based setting of hospitalised myocardial infarction. Heart. 2013 Jun;99(11):767–73.
O’Brien, Emily C., et al. “Medication, reperfusion therapy and survival in a community-based setting of hospitalised myocardial infarction.Heart, vol. 99, no. 11, June 2013, pp. 767–73. Pubmed, doi:10.1136/heartjnl-2012-303244.
O’Brien EC, Rose KM, Suchindran CM, Stürmer T, Chang PP, Chambless L, Guild CS, Rosamond WD. Medication, reperfusion therapy and survival in a community-based setting of hospitalised myocardial infarction. Heart. 2013 Jun;99(11):767–773.

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

June 2013

Volume

99

Issue

11

Start / End Page

767 / 773

Location

England

Related Subject Headings

  • United States
  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Survival Rate
  • Stents
  • Retrospective Studies
  • Population Surveillance
  • Platelet Aggregation Inhibitors
  • Myocardial Reperfusion
  • Myocardial Infarction