Guideline adherence and long-term clinical outcomes in patients with acute myocardial infarction: a Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) substudy. Issue 8 (1st December 2020)

• Record Type: Journal Article
• Authors: Wada, Hideki; Ogita, Manabu; Suwa, Satoru; Nakao, Koichi; Ozaki, Yukio; Kimura, Kazuo; Ako, Junya; Noguchi, Teruo; Yasuda, Satoshi; Fujimoto, Kazuteru; Nakama, Yasuharu; Morita, Takashi; Shimizu, Wataru; Saito, Yoshihiko; Hirohata, Atsushi; Morita, Yasuhiro; Inoue, Teruo; Okamura, Atsunori; Mano, Toshiaki; Hirata, Kazuhito; Tanabe, Kengo; Shibata, Yoshisato; Owa, Mafumi; Tsujita, Kenichi; Funayama, Hiroshi; Kokubu, Nobuaki; Kozuma, Ken; Uemura, Shiro; Toubaru, Tetsuya; Saku, Keijiro; Oshima, Shigeru; Nishimura, Kunihiro; Miyamoto, Yoshihiro; Ogawa, Hisao; Ishihara, Masaharu; Sato, Tadaya; Kyono, Hiroyuki; Tobaru, Tetsuya; Sone, Takahito; Sone, Yasuhiro; Fujino, Masashi; Nishimura, Kunihiko; Kotani, Junichi; Okura, Hiroyuki; Uematsu, Masaaki; Uemura, Shirou; Hokimoto, Seiji;
• Is Part Of: European heart journal. Volume 9:Issue 8(2020)
• Page Start: 939
• Page End: 947
• Publication Date: 2020-12-01
• Subjects: Acute myocardial infarction -- guideline adherence -- long-term clinical outcomes; 616.1205
• DOI: 10.1177/2048872620902024
• Languages: English
• ISSNs: 2048-8726

Abstract

Abstract : Background: The association between guideline adherence and long-term outcomes in patients with acute myocardial infarction in real-world clinical practice remains unclear. Methods: We investigated 3283 consecutive patients with acute myocardial infarction who were selected from a prospective, nation-wide, multicentre registry (J-MINUET) database covering 28 institutions in Japan between July 2012 and March 2014. Among the 2757 eligible patients, we evaluated the use of seven guideline-recommended therapies, including urgent revascularisation, door-to-balloon time of 90 minutes or less, and five discharge medications (P2Y12 inhibitors on aspirin, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, lipid-lowering drugs). The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure and urgent revascularisation for unstable angina up to 3 years. Results: The overall median composite guideline adherence was 85.7%. Patients were divided into the following three groups: complete (100%) adherence group ( n =862); moderate adherence (75% to <100%) group ( n =911); and low adherence (0–75%) group ( n =984). The rate of adverse cardiovascular events was significantly lower in the complete adherence group than in the low and moderate adherence groups (log rank P <0.0001). Multivariate Cox regression analysis showed complete guideline adherence was also significantly associated with lower adverse cardiovascular events compared with low guideline adherence (hazard ratio 0.66; 95% confidence interval 0.52–0.85; P =0.001). Conclusion: The use of guideline-based therapies for patients with acute myocardial infarction in contemporary clinical practice was associated with significant decreases in adverse long-term clinical outcomes. Trial registration: UMIN Unique trial Number: UMIN000010037