OBJECTIVE: Large randomized clinical trials have shown the efficacy of aspirin, 
ACE (angiotensin converting enzyme) inhibitors and statins as secondary 
prevention measures in patients after an acute coronary syndrome with and 
without ST elevations. Therefore we aimed to determine the effect of a 
combination therapy with these three drugs on 1-year mortality after acute 
myocardial infarction (AMI).
METHODS: We prospectively followed 9998 survivors of acute myocardial infarction 
treated with a beta-blocker for 1 year. Patients were divided into three groups 
according to their therapy with aspirin, ACE inhibitors and statins: 3 drugs, 2 
drugs or 0-1 drug.
RESULTS: The majority of patients (n = 6260, 62.6%) were treated with 3 drugs, 
2986 (29.9%) with 2 drugs and 752 (7.5%) with 0-1 drug. In the univariate 
analysis 1-year mortality was 4.9%, 9.7% and 13.6%, respectively. After 
adjusting for confounding factors in the propensity score analysis the odds 
ratios for 1-year mortality were significantly increased with 0-1 drug (odds 
ratio 1.67, 95% CI 1.24-2.27) and with 2 drugs (odds ratio 1.54, 95% CI 
1.26-1.87) in comparison with the group treated with all 3 drugs. However, in 
the ACOS registry the treatment was left to the discretion of the physician. 
This could lead to a selection bias, which cannot be fully eliminated by using 
multiple regression analysis.
CONCLUSIONS: A combination therapy with aspirin, an ACE inhibitor and a statin 
reduces 1-year mortality in patients after AMI. Therefore a polypill approach 
with these three agents should be considered to increase drug compliance and 
reduce mortality after acute myocardial infarction.