Yong Hoon Kim1, Ae-Young Her2, Myung Ho Jeong3, Byeong-Keuk Kim4, Seung-Yul Lee5, Sung-Jin Hong4, Dong-Ho Shin4, Jung-Sun Kim4, Young-Guk Ko4, Donghoon Choi4, Myeong-Ki Hong4, Yangsoo Jang4. 1. Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea. Electronic address: yhkim02@kangwon.ac.kr. 2. Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea. 3. Chonnam National University Hospital, Gwangju, South Korea. 4. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea. 5. Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, South Korea.
Abstract
BACKGROUND AND AIMS: We compared the clinical impact of renin-angiotensin system inhibitors (RASI) on long-term clinical outcomes between ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) after successful percutaneous coronary intervention (PCI) with drug eluting stents (DES) because of the paucity of published data. METHODS: A total of 24,960 acute myocardial infarction (AMI) patients who underwent PCI with DES and were prescribed the RASI were enrolled and divided into two groups, the STEMI group (n = 14,061) and the NSTEMI group (n = 10,899). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, cardiac death (CD), recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2 years. RESULTS: After propensity score-matched (PSM) analysis, two PSM groups (6762 pairs, n = 13,524, C-statistic = 0.682) were generated. All-cause death (hazard ratio [HR], 1.386; 95% confidence interval [CI], 1.114-1.725; p = 0.003) and CD (HR, 1.358; 95% CI, 1.041-1.770; p = 0.024) rates were significantly higher in NSTEMI patients. However, the incidence of MACE, re-MI, total revascularization, TLR, TVR, non-TVR was not significantly different between the two groups. In addition, old age (≥65years), decreased left ventricular ejection fraction (<50%), hypertension, creatine kinase isoenzyme level, cardiogenic shock, cardiopulmonary resuscitation on admission, and PCI within 24 h were common significant independent risk factors of all-cause death and CD. CONCLUSIONS: The mortality reduction capability of RASI was more prominent in the STEMI patients compared with the NSTEMI patients.
BACKGROUND AND AIMS: We compared the clinical impact of renin-angiotensin system inhibitors (RASI) on long-term clinical outcomes between ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) after successful percutaneous coronary intervention (PCI) with drug eluting stents (DES) because of the paucity of published data. METHODS: A total of 24,960 acute myocardial infarction (AMI) patients who underwent PCI with DES and were prescribed the RASI were enrolled and divided into two groups, the STEMI group (n = 14,061) and the NSTEMI group (n = 10,899). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, cardiac death (CD), recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2 years. RESULTS: After propensity score-matched (PSM) analysis, two PSM groups (6762 pairs, n = 13,524, C-statistic = 0.682) were generated. All-cause death (hazard ratio [HR], 1.386; 95% confidence interval [CI], 1.114-1.725; p = 0.003) and CD (HR, 1.358; 95% CI, 1.041-1.770; p = 0.024) rates were significantly higher in NSTEMI patients. However, the incidence of MACE, re-MI, total revascularization, TLR, TVR, non-TVR was not significantly different between the two groups. In addition, old age (≥65years), decreased left ventricular ejection fraction (<50%), hypertension, creatine kinase isoenzyme level, cardiogenic shock, cardiopulmonary resuscitation on admission, and PCI within 24 h were common significant independent risk factors of all-cause death and CD. CONCLUSIONS: The mortality reduction capability of RASI was more prominent in the STEMI patients compared with the NSTEMI patients.
Authors: Hamish C Prosser; Kah Yong Peck; Diem Dinh; Louise Roberts; Jaya Chandrasekhar; Angela Brennan; Stephen J Duffy; David Clark; Andrew E Ajani; Ernesto Oqueli; Martin Sebastian; Christopher M Reid; Melanie Freeman; Jithin K Sajeev; Andrew W Teh Journal: Clin Res Cardiol Date: 2022-01-20 Impact factor: 6.138