BACKGROUND:

Current guidelines recommend the use of betablockers, statins and renin-angiotensin-system-inhibitors (RAS) in addition to dual antiplatelet therapy (DAPT) for secondary prevention following acute MI. However the prevalence and correlates of optimal medical therapy (OMT) in clinical practice remains unknown.

METHODS:

PROMETHEUS was a multicenter observational US study in patients undergoing PCI. We included 2389 STEMI and 4450 NSTEMI patients. OMT was defined as discharge on a beta-blocker, statin and RAS, in addition to DAPT. Independent correlates of discharge on OMT were identified using multivariable logistic regression. Adjusted Cox-regression analyses for major adverse cardiac events (MACE) at 1- year were estimated.

RESULTS:

Patients discharged on OMT (n¼4687, 69%) were younger with less frequent history of PCI, peripheral and cerebral vascular disease and multivessel disease compared with those not receiving OMT (n¼2152, 31%). Adjusted predictors of OMT were ST-elevation MI presentation, hypertension, diabetes mellitus, left ventricular ejection fraction

CONCLUSION: In contemporary US practice, OMT is prescribed in two thirds of MI patients undergoing PCI. Chronic kidney disease and anemia are independent predictors of reduced OMT prescription.