Estimating mortality in survivors of the acute coronary syndrome by the 4-drug score

Objective: Four drug classes, platelet inhibitors, β-blockers, statins, and angiotensin-converting enzyme inhibitors (or angiotensin receptor blockers), have been shown to reduce mortality in clinical trials. We sought to evaluate whether the simple number of secondary prevention drugs at discharge is independently associated with 1-year mortality in acute coronary syndrome (ACS) patients. Methods: We analyzed a prospective cohort study using data of all 5 Acute Coronary Syndrome Israeli Surveys (ACSIS) conducted between 2002 and 2010 in all Israeli cardiology departments. All 9,107 hospital survivors of ACS participated. Results: A score from 1 to 4 discharge drugs was significantly associated with gradual decreasing rates of 1-year mortality (14.4, 9.0, 5.1, and 3.6%, respectively; p for trend <0.001). Only when the number of discharge drugs increased to 3-4 as a result of the intervention during hospitalization in patients initially admitted with 0-2 drugs, a significant multivariate-adjusted decrease in the hazard ratio (HR), independent of multiple baseline, admission presentation, and in-hospital course characteristics, was measured (HR, 0.66; 95% confidence interval, 0.50-0.87). Conclusion: The use of a higher number of secondary prevention drugs at discharge following ACS was associated with significantly lower mortality rates, particularly in patients with mono- or dual-baseline therapy.