Impact of guideline-directed medical therapy on the cardiac or non-cardiac death in acute myocardial infarction

Background/Aims: While the clinical effectiveness of guideline-directed medical therapy (GDMT) is well established in patients with acute myocardial infarction (AMI), its specific impact on cause-specific mortality remains unclear. This study aimed to investigate the impact of GDMT on both cardiac and non-cardiac mortality in AMI patients. Methods: Data of the KAMIR-NIH, a multicenter prospective registry of AMI in Korea between 2011 and 2015, were included. The competing risks of cardiac and non-cardiac death in patients who received GDMT were compared with those who did not, using a multivariable-adjusted cumulative incidence analysis of propensity score-matched patients. Primary endpoint of interest was 3-year cardiac and non-cardiac mortality. Results: Of the 12,815 patients enrolled, 2,700 matched pairs with a mean age of 64.9 ± 12.2 years were analyzed. The cumulative incidence of cardiac death (5.0% vs. 8.6%; subdistribution hazard ratio [sHR] 0.53; 95% CI 0.43–0.67) and non-cardiac death (3.2% vs. 4.5%; sHR 0.69; 95% CI 0.52–0.92) was significantly lower in patients receiving GDMT compared to those who did not (all p < 0.05). These results were also consistent in 30-day landmark analyses. Conclusions: In patients with AMI, the use of GDMT was linked to a reduced risk of both cardiac and non-cardiac death over a period of 3 years. These findings support the continued adoption of GDMT in clinical practice.