Benefits of combination therapy for acute coronary syndromes seen within six months
Use of evidenced-based combination therapy in patients with acute coronary syndromes can result in a “striking survival advantage” within six months, say US researchers.
They examined the hospital records of 1,358 patients who had been diagnosed
with acute coronary syndromes.
They determined whether use of
antiplatelet drugs, beta-blockers, angiotensin converting enzyme inhibitors
and lipid-lowering agents were appropriate for each patient and recorded
whether any of these drugs were prescribed to patients on discharge from
hospital.
Those patients who were prescribed all four types of drugs had a 90 per
cent lower risk of dying in the six months after they left hospital than
those who received none of the drugs (odds ratio 0.10, 95 per cent confidence
interval 0.03 to 0.42, P<0.0001). Patients who received two or three
of the drugs were also less likely to die than those who received none
(odds ratio 0.18 and 0.17, respectively).
“We knew that each of these kinds of drugs works pretty well alone,
but we never expected that together they would be this powerful at improving
survival,” say the authors. “These results clearly show that
the effect of combination therapy is synergistic, not just additive.”
Commenting on the study findings, the authors of an accompanying editorial
conclude: “It is not sufficient to simply add one therapy at a
time in patients at high risk of future ischaemic events. Instead, wherever
clinically possible, patients should be started simultaneously on as
many as four evidence-based therapies while they are still in
hospital.”
The study and editorial are published in Circulation (2004;109:745 and
698). |
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