Clinical Importance of Optimal Medical Therapy on the Clinical Outcomes of Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

Objective Optimal medical therapy (OMT) is recommended for the secondary prevention of acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). We investigated the relationship between the OMT prescription rate at hospital discharge and clinical outcomes in patients with AMI who underwent successful PCI. Methods We enrolled 294 consecutive AMI patients who underwent successful emergency PCI between January 2017 and December 2020. The patients were divided into two groups based on their medications at discharge: OMT, defined as a combination of statins, beta-blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers; and non-OMT, defined as the absence of at least one of the aforementioned agents. The primary outcome measure was major adverse cardiovascular events (MACEs), defined as the composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and heart failure requiring hospitalization. Results According to prescription data, 186 patients (63.3%) were prescribed OMT at discharge. During a median follow-up period of 957 (591-1,308) days, 45 patients developed MACEs. Kaplan-Meier curves showed a significantly lower incidence of MACE in the OMT group than in the non-OMT group (log-rank p<0.001). In the multivariate analysis, OMT remained independently associated with a reduced risk of MACE (hazard ratio, 0.47; 95% confidence interval: 0.25-0.88; p=0.017). Conclusion Fundamental OMT at discharge was associated with a reduced risk of MACE in AMI patients after successful PCI. Therefore, OMT may be necessary to improve the clinical outcomes of patients with AMI after discharge.