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Medication use before hospitalization lowered risk for STEMI in patients with first acute MI

Björck L. Arch Intern Med. 2010;170:1293-1301.

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Patients with a first acute MI who took medication — aspirin, beta-blockers, ACE inhibitors or statins — before hospital admission had a lower risk of presenting with STEMI, according to new study findings.

The study population included 103,459 consecutive patients from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) admitted between 1996 and 2006 who had a first acute MI.

Researchers reported that the patients with STEMI (n=45,027, 43.5%) were younger, had less prior CVD and used fewer medications before hospitalization. Overall, 61.4% of STEMI patients used no medication vs. 45.9% in the non-STEMI group. Patients who used aspirin, beta-blockers, ACE inhibitors and statins before hospitalization had lower odds of presenting with STEMI. The risk decreased with the number of previous medications, with at least three medications being associated with a multiply adjusted OR of presenting with STEMI of 0.48 (99% CI, 0.44-0.52) vs. no medications at admission.

Among study patients, researchers concluded that “previous treatment with aspirin, beta-blockers, ACE inhibitors and statins was substantially associated with less risk of presenting with STEMI, a more damaging and severe acute MI. Increasing use of preventive medications in the population could contribute to decreasing severity in acute MI, further emphasizing the importance of medical treatment in patients perceived to be at high risk.”

However, in an accompanying editorial, Eyal Herzog, MD, and Fahad Javed, MD, both with Columbia University in New York, said before physicians too strongly embrace pharmacological treatment, they should remember that the risk for MI is almost entirely attributable to modifiable CV risk factors.

“An extensive body of data demonstrates the positive impact of cessation of smoking, an increase in physical exercise, reduction of body weight, control of hypertension and correction of dyslipidemias,” they wrote. “Unfortunately, adherence to evidence-based pharmacologic treatment and lifestyle modifications are sub-optimal in various populations. We know what works; now we have to put our evidence to use.”

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