The greatest reduction in MACE was observed among patients receiving both BB and ACEI/ARB at discharge, regardless of LVEF. of 12-month all-cause mortality. Combined BB and ACEI/ARB was associated with the least expensive incidence of all-cause mortality and HF hospitalization. and were recognized from hospital discharge records, troponin test results, reimbursement claims and the national death registry by trained coordinators from the SMIR. Healthcare legislature in Singapore mandates that all patients diagnosed with AMI are enrolled in the SMIR with the exception of patients who opt out of enrolment. This study complies to the Helsinki declaration and was approved by the National Healthcare Group Domain Specific Review Board which allowed for a waiver of written informed consent on condition that all analyses were performed onsite at the SMIR using BX471 hydrochloride de-identified data. We included all patients with a primary diagnosis DCHS1 of AMI and who received inhospital coronary revascularization by PCI or coronary artery bypass graft surgery (CABG) during the index hospitalization. We excluded (1) patients who were admitted for non-AMI condition but had AMI during hospitalization, (2) AMI that were not clearly classified (not STEMI or non-STEMI), (3) patients who did not receive inhospital revascularization, and (4) patients who died during index hospitalization. Data collection and clinical outcomes Information on demographics, co-morbidities, history of coronary revascularization, clinical presentation, inpatient laboratory values, LVEF and pharmacotherapy on discharge were prospectively collected by trained coordinators according to a standardized case report form (https://www.nrdo.gov.sg/docs/default-source/Disease-NotificationAMI/nrdo-f004-09b-(smir-notification-form)web.pdf?sfvrsn=0). Prior to 2008, LVEF data in the registry was captured in binary format (LVEF?50% vs??50%). From 2008 onwards, LVEF was captured as continuous data. The outcome of interest was major adverse cardiovascular events (MACE), which we defined as a composite of all-cause mortality, hospitalization for HF or hospitalization for MI, and the individual component endpoints. Death endpoints were ascertained through data linkage with the Ministry of Home Affairs Death Registry while MI hospitalization and HF hospitalization were ascertained by linking SMIR data with the Ministry of Health Mediclaims data. Only the first hospitalization for HF or MI after discharge was included and time to hospitalization was computed as the number of days from BX471 hydrochloride the discharge date of the index admission to the readmission date. Statistical analysis For descriptive analyses, we compared baseline demographic and clinical characteristics of patients stratified to BB versus no BB and ACEI/ARB versus no ACEI/ARB. Categorical variables are shown using frequencies and percentages, and continuous variables are presented using median and interquartile range. Differences between the groups were compared by using Chi-square test for categorical variables and MannCWhitneyCWilcoxon nonparametric test for continuous variables. Multivariable Cox proportional hazard regression models were constructed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the risk of composite endpoint, all-cause BX471 hydrochloride mortality, MI and HF hospitalization, for patients who were given (1) BB and those who were not given (reference group) and (2) ACEI/ARB compared to those who were not given these medications (reference group). Included in the multivariable models were age, gender, ethnicity, hypertension, diabetes, hyperlipidemia, history of MI/PCI/CABG, smoking status, Killip class on admission, creatinine level on admission and in-hospital LVEF?50%. We further constructed another similar multivariable Cox proportional hazard regression model for patients who received both BB and ACEI/ARB (BB?+?ACEI/ARB), BB only, ACEI/ARB only, comparing them with the reference group of patients were on neither BB nor ACEI/ARB (no BB?+?no ACEI/ARB group). Competing risks from death was accounted for all hospitalization outcomes19. Secondary subgroup analysis examined clinical outcomes stratified by the following categories: types of AMI (STEMI or NSTEMI), age (65?years old or ?65?years old),.