Clinical impacts of inhibition of renin–angiotensin system in patients with acute ST-segment elevation myocardial infarction who underwent successful late percutaneous coronary intervention. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Park, Hyukjin; Kim, Hyun Kuk; Jeong, Myung Ho; Cho, Jae Yeong; Lee, Ki Hong; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Hong, Young Joon; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jim; Jeong, Myung Ho; Kim, Young Jo; Kim, Chong Jin; Cho, Myeong Chan; Ahn, Young Keun; Kim, Jong Hyun; Chae, Shung Chull; Hur, Seung Ho; Seong, In Whan; Hong, Taek Jong; Choi, Dong Hoon; Chae, Jei Keon; Rhew, Jae Young; Kim, Doo Il; Chae, In Ho; Yoon, Jung han; Koo, Bon Kwon; Kim, Byung Ok; Lee, Myoung Yong; Kim, Kee Sik; Hwang, Jin Yong; Oh, Seok Kyu; Lee, Nae Hee; Jeong, Kyoung Tae; Tahk, Seung Jea; Bae, Jang Ho; Rha, Seung Woon; Park, Keum Soo; Han, Kyoo Rok; Ahn, Tae Hoon; Kim, Moo Hyun; Yang, Joo Young; Rhim, Chong Yun; Gwon, Hyeon Cheol; Park, Seong Wook; Koh, Young Youp; Joo, Seung Jae; Kim, Soo Joong; Jin, Dong Kyu; Cho, Jin Man; Chung, Wook Sung; Jang, Yang Soo; Cho, Jeong Gwan; Seung, Ki Bae; Park, Seung Jung;
• Is Part Of: Journal of cardiology. Volume 69:Issue 1(2017:Jan.)
• Page Start: 216
• Page End: 221
• Publication Date: 2017-01
• Subjects: Renin–angiotensin system -- Myocardial infarction -- Prognosis -- Myocardial revascularization; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2016.03.012
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: Successful percutaneous coronary intervention (PCI) of the occluded infarct-related artery (IRA) in latecomers may improve long-term survival mainly by reducing left ventricular remodeling. It is not clear whether inhibition of renin–angiotensin system (RAS) brings additional better clinical outcomes in this specific population subset. Methods: Between January 2008 and June 2013, 669 latecomer patients with acute ST-segment elevation myocardial infarction (STEMI) (66.2 ± 12.1 years, 71.0% males) in Korea Acute Myocardial Infarction Registry (KAMIR) who underwent a successful PCI were enrolled. The study population underwent a successful PCI for a totally occluded IRA. They were divided into two groups according to whether they were prescribed RAS inhibitors at the time of discharge: group I (RAS inhibition, n = 556), and group II (no RAS inhibition, n = 113). Results: During the one-year follow-up, major adverse cardiac events (MACE), which consist of cardiac death and myocardial infarction, occurred in 71 patients (10.6%). There were significantly reduced incidences of MACE in the group I (hazard ratio = 0.34, 95% confidence interval 0.199–0.588, p = 0.001). In subgroup analyses, RAS inhibition was beneficial in patients with male gender, history of hypertension or diabetes mellitus, and even in patients with left ventricular ejection fraction (LVEF) ≥40%. In the baseline and follow-up echocardiographic data, benefit in changes of LVEF and left ventricular end-systolic volume was noted in group I. Conclusions: In latecomers with STEMI, RAS inhibition improved long-term clinical outcomes after a successful PCI, even in patients with low risk who had relatively preserved LVEF.