Discontinuation of medications 1 month after an acute myocardial infarction increased risk for death at 12 months.

M e t h o d s Design: Cohort study (Prospective Registry Evaluation Myocardial Infarction: Event and Recovery [PREMIER]). Setting: 19 academic centers, inner-city hospitals, single-payer systems, and nonuniversity hospitals in the United States. Patients: 2498 patients ≥ 18 years of age (mean age 60 y, 71% men, 79% white) who had biomarker evidence of myocardial necrosis within 24 hours of admission or who were transferred to the hospital within 24 hours of onset of symptoms and had acute MI (ischemic signs, symptoms for > 20 min, or electrocardiographic ST changes). Risk factors: Discontinuation of 1 or more of 3 evidence-based medications (aspirin, βblocker, or statins) at 1 month after MI. Results were adjusted for age, sex, race, educational level, marital status, smoking status, diabetes, hypercholesterolemia, hypertension, heart failure, coronary heart disease, revascularization during index hospitalization, type of MI, social support, avoidance of medication because of cost, and site of enrollment. Outcome: Death at 12 months.