Coronary disease & ACSCohort study
Pharmacological treatment after a first myocardial infarction in Sweden—long-term adherence and prognosis
- Time-updated survival analyses of a national register cohort
- Swedish National Inpatient Register linked to the Prescribed Drug Register
Authors' conclusion
The use of all GDMT is associated with lower risk for all-cause mortality and recurrent myocardial infarction. Long-term adherence of GDMT is suboptimal and there is a potential for further improvement.
Study context
- Population
- Patients aged 18–84 years hospitalized with a first acute myocardial infarction (MI) between 2006 and 2022 in Swedenindividuals with acute MI (29.3% women)
- Participants
- 96,272 patients
- Exposure
- Relationship between guideline-directed medical therapy (GDMT) and mortality and/or recurrent MI
Main finding
As reported in the abstract
Use of GDMT · first year after MI
- Use of GDMT decreased markedly
Observational data: associations, not effects.
Further findings
All-cause mortality or recurrent MI
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| antiplatelet/OAC · lower risk; all P < 0.0001 · time-updated survival analyses | 0.76 (0.74–0.78) | P < 0.0001 | |
| lipid lowering therapy · lower risk; all P < 0.0001 · time-updated survival analyses | 0.68 (0.67–0.70) | P < 0.0001 | |
| ACEi/ARB · lower risk; all P < 0.0001 · time-updated survival analyses | 0.81 (0.79–0.83) | P < 0.0001 | |
| 0.512Hazard ratio (log scale) |
All-cause mortality or recurrent MI, beta-blockers
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| beta-blockers · slightly increased risk | 1.04 (1.02–1.07) | P = 0.0005 | |
| 0.512Hazard ratio (log scale) |
Death · median follow-up of 5.6 years
- Died
- 32.9%
Baseline characteristics
- hypertension
- 48.4%
- diabetes mellitus
- 18.8%
- heart failure
- 13.5%
Original publication
Pharmacological treatment after a first myocardial infarction in Sweden—long-term adherence and prognosis. Eur Heart J Qual Care Clin Outcomes. Published 26 March 2026. doi:10.1093/ehjqcco/qcag050
Summarised from the published abstract; every number is checked against it