Background: Randomized trials have shown that several medications reduce the risk for recurrent coronary heart disease (CHD) events following myocardial infarction (MI). Knowing the risk for recurrent events among patients receiving intensive medical management following MI can inform patient-physician shared decision making.
Objective: To estimate the risk for CHD events among patients receiving intensive medical management following an MI hospitalization.
Methods: We identified US adults 18-64 years with commercial health insurance in Marketscan who had an MI hospitalization (defined by an ICD-9 code of 410.x0 or 410.x1 in the primary discharge diagnosis position) in 2014-2015. Intensive medical management was defined as filling a high-intensity statin, renin-angiotensin system inhibitor, beta-blocker and antiplatelet agent within 30 days following hospital discharge for MI. Patients receiving intensive medical management were matched 1:2 by age, sex and calendar year to randomly selected controls from the general population and followed for recurrent MI and CHD events (i.e., MI or coronary revascularization).
Results: Among MI patients (n=17,643, mean age 55 years, 74% male), 29.6% received intensive medical management. After adjustment for comorbid conditions, intensive medical management was more common among men (relative risk [95% CI] 1.14 [1.07, 1.20]), those who received a stent during their MI hospitalization (2.54 [2.37, 2.73]) and those who received cardiologist care (1.17 [1.11, 1.22]) and cardiac rehabilitation (1.14 [1.08, 1.20]) after hospital discharge. The risk for recurrent MI and CHD events was higher among MI patients receiving intensive medical management compared to controls, overall and when restricted to MI patients with high medication adherence (Table).
Conclusion: MI patients receiving intensive medical management have a substantial residual risk for recurrent CHD events.