{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:58:36Z","timestamp":1788483516039,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP 1115163"],"award-info":[{"award-number":["APP 1115163"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","award":["Award ID 101130"],"award-info":[{"award-number":["Award ID 101130"]}],"id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Optimal secondary prevention pharmacotherapy is the cornerstone of post\u2010acute coronary syndrome (ACS) management. The prognostic impact of not receiving five guideline\u2010recommended therapies is poorly described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To ascertain the prognostic significance of suboptimal pharmacotherapy in ACS survivors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive patients with ACS from the Melbourne Interventional Group registry who were alive at 30\u2009days following their index percutaneous coronary intervention were included. Patients were divided into three categories based on the number of secondary prevention medications prescribed. The optimal medical therapy (OMT), near\u2010optimal medical therapy (NMT), suboptimal medical therapy (SMT) groups were prescribed 5, 4 and \u2264\u20093 medications, respectively. Primary endpoint was long\u2010term mortality. Cox\u2010proportional hazard modelling was undertaken to assess independent predictors of survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 9375 patients included, 5678 (60.6%) received OMT, 2903 (31.0%) received NMT and 794 (8.5%) received SMT. Patients receiving SMT were older, more likely to be female and had higher burden of comorbidities (renal impairment, congestive heart failure, diabetes, peripheral vascular disease; <jats:italic>P<\/jats:italic> &lt;\u20090.01 for all). SMT was associated with higher long\u2010term mortality at 3.9 \u00b1\u20092.2\u2009years when compared to NMT and OMT (16.8% vs 10.5% vs 8.2%, <jats:italic>P<\/jats:italic> &lt;\u20090.001). Compared to OMT, SMT was an independent predictor of long\u2010term mortality (hazard ratio, HR 1.62, 95% confidence interval, CI 1.30\u20132.02, <jats:italic>P<\/jats:italic> &lt;\u20090.01) while NMT was associated with a clinically significant 14% mortality hazard (HR 1.14, 95% CI 0.97\u20131.34, <jats:italic>P<\/jats:italic> =\u20090.11).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is a graded long\u2010term hazard associated with not receiving OMT after an ACS. Improvements in secondary prevention pharmacotherapy models of care are warranted to further decrease the long\u2010term mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.14750","type":"journal-article","created":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T10:36:17Z","timestamp":1578998177000},"page":"366-374","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Prognostic significance of suboptimal secondary prevention pharmacotherapy after acute coronary syndromes"],"prefix":"10.1111","volume":"51","author":[{"given":"Matias B.","family":"Yudi","sequence":"first","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Farouque","sequence":"additional","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Andrianopoulos","sequence":"additional","affiliation":[{"name":"Centre of Cardiovascular Research and Education in Therapeutics (CCRE) Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew E.","family":"Ajani","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Melbourne  Melbourne Victoria Australia"},{"name":"Centre of Cardiovascular Research and Education in Therapeutics (CCRE) Monash University  Melbourne Victoria Australia"},{"name":"Department of Cardiology Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Brennan","sequence":"additional","affiliation":[{"name":"Centre of Cardiovascular Research and Education in Therapeutics (CCRE) Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4248-7537","authenticated-orcid":false,"given":"Alexandra C.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Lefkovits","sequence":"additional","affiliation":[{"name":"Centre of Cardiovascular Research and Education in Therapeutics (CCRE) Monash University  Melbourne Victoria Australia"},{"name":"Department of Cardiology Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Reid","sequence":"additional","affiliation":[{"name":"Centre of Cardiovascular Research and Education in Therapeutics (CCRE) Monash University  Melbourne Victoria Australia"},{"name":"School of Public Health, Curtin University  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Oqueli","sequence":"additional","affiliation":[{"name":"Department of Cardiology Ballarat Base Hospital  Ballarat Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Department of Cardiology Barwon Health  Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4518-5948","authenticated-orcid":false,"given":"Stephen J.","family":"Duffy","sequence":"additional","affiliation":[{"name":"Centre of Cardiovascular Research and Education in Therapeutics (CCRE) Monash University  Melbourne Victoria Australia"},{"name":"Department of Cardiology Alfred Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Melbourne Interventional Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa053935"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.580"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.10.063"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000133"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.10.824"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182742c84"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2011.12.013"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.706820"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.768986"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.17.1842"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.09.014"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi705"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.12.011"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000112577.69066.CB"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.505636"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.2.177"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.05.003"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2005.08.001"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2010.10.002"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2010.11.001"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067722"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2016.06.789"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2012.05.127"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.963959"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.07.028"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-012-0322-6"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra050100"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.13736"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.919415"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-016-0356-6"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)62177-1"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1410489"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1107913"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2019.01.004"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.578"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.3109\/08037051.2016.1139324"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1500857"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409312"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fimj.14750","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.14750","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.14750","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.14750","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T10:18:17Z","timestamp":1693563497000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.14750"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":41,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1111\/imj.14750"],"URL":"https:\/\/doi.org\/10.1111\/imj.14750","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3]]},"assertion":[{"value":"2019-10-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}