ADHERENCE TO OPTIMAL MEDICAL THERAPY: A KEY DETERMINANT OF CLINICAL OUTCOMES IN ACUTE CORONARY SYNDROME PATIENTS WITH REDUCED LVEF AFTER PTCA
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Background: Acute myocardial infarction (AMI), as a significant manifestation of coronary artery disease (CAD), globally presents a leading cause of morbidity and mortality. The advancement in percutaneous coronary intervention (PCI), thrombolysis, and pharmacotherapy have improved management outcomes significantly. Yet, optimizing post-AMI patient outcomes, particularly for those undergoing angioplasty with reduced ejection fractions, necessitates adherence to Optimal Medical Therapy (OMT). Methods: This comparative observational study was conducted at Jubilee Mission Medical College & Research Institute, Thrissur, from January 2017 to January 2018, encompassing 106 ACS patients undergoing PCI with an ejection fraction less than forty percent. Data were collected on baseline characteristics, clinical outcomes, and OMT adherence, assessed at discharge and at 1.5, 3.5, 6.5 months, and 1-year intervals. OMT adherence was categorized into full adherence, suboptimal doses, and non-adherence groups, based on prescribed medications and lifestyle modifications. Results: Among the initial 106 patients, 96 completed the study. By the year's end, 53.13% of patients fully adhered to OMT, showed significant improvements in NYHA classification, ejection fraction, reduced hospital readmissions, and revascularization needs. Mortality rate stood at 8.33%, predominantly among those non-adherent to OMT. These findings underscore the critical impact of OMT adherence on improving post-angioplasty outcomes in ACS patients. Discussion: The study findings corroborate existing literature underscoring the efficacy of OMT in post-ACS management, highlighting the need for rigorous implementation and personalized management strategies to enhance adherence. The study's observational design and its single-center nature suggest the need for broader, multi-centric research to validate these outcomes further. Conclusion: Adherence to OMT significantly reduces morbidity and mortality while enhancing cardiac function and quality of life in ACS patients with reduced LVEF post-angioplasty. This study reinforces the indispensable role of OMT in ACS management, advocating for enhanced patient education and tailored approaches to ensure optimal therapeutic adherence and outcomes.
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