Figure 1
The level of adherence in prescribing individual medications (aspirin, clopidogrel, anticoagulants, statins) and all-combined medications in non-reperfused STEMI patients during hospitalization.
Table 1
Baseline characteristics of patients with ST-segment elevation myocardial infarction not receiving acute reperfusion therapy.
| Patient’s characteristicsa | Guideline-adherent (N = 778) | Guideline non-adherent (N = 354) | p-valueb | Missing observation (% of total N) |
|---|---|---|---|---|
| Age > 65 years, n (%) | 144 (18.5) | 67 (18.9) | 0.867 | 0 |
| Males, n (%) | 669 (86.0) | 294 (83.1) | 0.198 | 0 |
| Source of referral, n (%) | ||||
| Inter-hospital | 399 (51.2) | 200 (56.5) | 0.437 | 0 |
| Walk in/ambulance | 335 (43.1) | 137 (38.7) | ||
| Intra-hospital | 30 (3.9) | 12 (3.4) | ||
| Primary physician | 14 (1.8) | 5 (1.4) | ||
| IHD risk factors, n (%) | ||||
| Family history of CAD | 134 (17.2) | 48 (13.6) | 0.120 | 0 |
| Hypertension | 406 (52.2) | 175 (49.4) | 0.391 | 0 |
| Diabetes | 250 (32.1) | 114 (33.2) | 0.981 | 0 |
| Dyslipidemia | 227 (29.2) | 99 (28.0) | 0.677 | 0 |
| Smokers | 499 (64.1) | 212 (59.9) | 0.170 | 0 |
| Hospital findings, n (%) | ||||
| Onset of STEMI ≤ 12 h | 161 (20.8) | 113 (32.4) | <0.0005 | 10 (0.9) |
| Anterior MI | 480 (61.9) | 219 (62.4) | 0.863 | 5 (0.4) |
| Killip class > 1 | 270 (35.1) | 158 (46.7) | <0.0005 | 25 (2.2) |
| TIMI score ≥ 4 | 367 (48.3) | 177 (55.8) | 0.024 | 55 (4.9) |
| Random blood glucose ≥ 200 mg/dL | 198 (25.8) | 97 (29.4) | 0.220 | 35 (3.1) |
| Other medications administered after admission, n (%) | ||||
| GP IIb/IIIa inhibitors | 11 (1.4) | 5 (1.4) | 0.998 | 0 |
| Beta blockers | 214 (27.5) | 96 (27.3) | 0.935 | 2 (0.2) |
| ACEIs/ARBs | 421 (54.1) | 167 (47.4) | 0.038 | 2 (0.2) |
[i] a Percentage was calculated as the number of patients with a certain characteristic per total number in each group excluding any missing observations.
b χ2 test, bold type indicated statistical significance.
ACEIs = angiotensin-converting enzyme inhibitors, ARBs = angiotensin receptor blockers, CAD = coronary artery disease, GP = glycoprotein, h = hour, IHD = ischemic heart disease, MI = myocardial infarction, STEMI = ST-segment elevation myocardial infarction, TIMI = thrombolysis in myocardial infarction.
Table 2
Distribution of potential confounders between non-reperfused STEMI patients who were alive and deceased during hospitalization.
| Potential confoundersa | Deceased (N = 138) | Alive (N = 994) | p-valueb | Missing observation (% of total N) |
|---|---|---|---|---|
| Hospital findings, n (%) | ||||
| Onset of STEMI ≤ 12 h | 46 (34.1) | 228 (23.1) | 0.005 | 10 (0.9) |
| Killip class > 1 | 95 (72.5) | 333 (34.1) | <0.0005 | 25 (2.2) |
| TIMI score ≥ 4 | 98 (81.7) | 446 (46.6) | <0.0005 | 55 (4.9) |
| Medications administered after admission, n (%) | ||||
| ACEIs/ARBs | 39 (28.5) | 549 (55.3) | <0.0005 | 2 (0.2) |
[i] a Percentage was calculated as the number of patients with a certain characteristic per total number in each group excluding missing observation.
b χ2 test, bold type indicated statistical significance.
ACEIs = angiotensin-converting enzyme inhibitors, ARBs = angiotensin receptor blockers, h = hour, STEMI = ST-segment elevation myocardial infarction, TIMI = thrombolysis in myocardial infarction.
Table 3
Association between adherence to guideline-recommended medications and in-hospital mortality in non-reperfused STEMI patients.
| In-hospital mortality | Adjusted OR (95% CI)a | ||
|---|---|---|---|
| N of death/total (%) | Crude OR (95% CI) | ||
| Guideline-adherentb | 62/778 (8.0) | 0.32 (0.22–0.46) | 0.46 (0.30–0.70) |
| Guideline non-adherentc | 76/354 (21.5) | ||
[i] a Adjusted for onset of STEMI, Killip class, TIMI score and administration of ACEIs/ARBs.
b Guideline-adherent was defined as receiving a combination of all four medications (aspirin, clopidogrel, anticoagulant and statins).
c Guideline non-adherent was defined as receiving less than four medications.
ACEIs = angiotensin-converting enzyme inhibitors, ARBs = angiotensin receptor blockers, CI = confidence interval, OR = odds ratio, STEMI = ST-segment elevation myocardial infarction, TIMI = thrombolysis in myocardial infarction.