Abstract
Objective
o investigate the impact of guideline-directed medical therapy (GDMT) during hospitalization on the prognosis of heart failure patients after acute anterior myocardial infarction.
Methods
From May 2017 to September 2022, 317 heart failure patients treated at a single center after acute anterior myocardial infarction were retrospectively investigated and analyzed based on whether GDMT during hospitalization for preventing ventricular remodeling (using at least one type of RAAS inhibitor, β receptor blocker, MRA, or SGLT2 inhibitor) was used. Patients who underwent percutaneous coronary intervention (PCI) were divided into two groups: the GDMT group (n=236) and the non-GDMT group (n=81), with a follow-up period of 12 months after PCI. The primary endpoint was the composite endpoint of all-cause death and all-cause readmission during follow-up.
Results
The incidence of primary endpoint events (10.2% vs. 19.8%, P=0.025), cardiac mortality and cardiac readmission composite events (7.2% vs. 14.8%, P=0.013), all-cause readmission events (9.3% vs. 19.8%, P=0.013), and cardiac readmission events (6.4% vs. 14.8%, P=0.019) in the GDMT group were lower than those in the non-GDMT group. Cox regression analysis revealed that the incidence of primary endpoint events, cardiac mortality and cardiac readmission composite endpoint events, all-cause readmission events, and cardiac readmission events in patients in the GDMT group were 0.397 times (HR 0.397; 95% CI0.207-0.759; P=0.005), 0.348 times (HR 0.348; 95% CI0.162-0.746; P=0.007), 0.377 times (HR 0.377; 95% CI0.195-0.730; P=0.004) and 0.320 times (HR 0.320; 95% CI0.146-0.700; P=0.004), respectively, than that in patients in the non-GDMT group. The benefits of primary endpoint events mainly come from readmission events.
Conclusion For heart failure patients who undergo PCI with acute anterior myocardial infarction, the GDMT during hospitalization reduces the incidence of readmission. And it is important to actively initiate GDMT as early as possible.