Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis.

Background

Survivors of myocardial infarction have an elevated risk of long-term mortality. We sought to evaluate guideline-directed medical treatment and its impact on long-term mortality in survivors of ST-elevation myocardial infarction (STEMI) according to their chronic kidney disease (CKD) stage.

Methods

Using German health insurance claims data, 157 663 hospitalized survivors of STEMI were identified. Regarding different CKD stages, we retrospectively analysed the filled prescriptions of platelet inhibitors (PAI)/oral anticoagulation, statins, beta-blocker and angiotensin-converting enzyme inhibitors/angiotensin II type 1 receptor antagonists (ACE-I/AT1-A) and their association with long-term mortality.

Results

Prescription rates for all four guideline-directed drugs were highest in patients without or with mild CKD and lowest in patients on dialysis. They dropped from 73.4% to 39.2% in patients without CKD and from 47.1% to 29% in patients on dialysis within the 5-year follow-up period. Mortality rates were dramatically increased in patients with CKD compared with patients without CKD (5-year mortality: no CKD, 16.7%; CKD stage 3, 47.1%; CKD stage 5d, 69.7%). Filled prescriptions of at least one drug class [one drug: hazard ratio (HR) 0.70, 95% confidence interval (95% CI) 0.66-0.74; four drugs: HR 0.28, 95% CI 0.27-0.30;

Conclusions

An improved long-term guideline-recommended drug therapy after STEMI regardless of renal impairment might lead to beneficial effects on long-term mortality.

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.

Déclaration de conflit d'intérêts

C.E. has received travel support from Abbott outside the submitted work. L.M. has received travel support from Bayer Vital and Abbott outside the submitted work. S.A.L. reports travel support from Daiichi Sankyo and Bayer Vital, outside the submitted work. J.G. has received honoraria from TESARO, QUIRIS Healthcare, Ecker + Ecker, Dr August Wolff, Roche, University Hospital Schleswig-Holstein and RWTH Aachen University, all outside the submitted work. H.R. has received speaker honoraria from NeoVasc, Corvia, BMS, MedUpdate, StremedUp, NephroUpdate and Pfizer. He has acted as a consultant for BMS, Pfizer and Pluristem, receiving in part also financial compensations for this work. He has received research grants from the German Federal Ministry for Education and Research (BMBF). His division within the University Hospital of Muenster has taken or is still taking in multicentre trials of BARD, Bayer, BIOTRONIK, Novartis and Pluristem, receiving patient fees and financial compensation for these efforts. All other authors declare no conflict of interest.