A comparison between statin with ACE inhibitor or ARB therapy in STEMI patients who underwent successful PCI with drug-eluting stents. (October 2019)

• Record Type: Journal Article
• Authors: Kim, Yong Hoon; Her, Ae-Young; Jeong, Myung Ho; Kim, Byeong-Keuk; Hong, Sung-Jin; Kim, Seunghwan; Ahn, Chul-Min; Kim, Jung-Sun; Ko, Young-Guk; Choi, Donghoon; Hong, Myeong-Ki; Jang, Yangsoo
• Is Part Of: Atherosclerosis. Volume 289(2019)
• Page Start: 109
• Page End: 117
• Publication Date: 2019-10
• Subjects: Myocardial infarction -- Statin -- Angiotensin converting enzyme inhibitor -- Angiotensin receptor blocker; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2019.08.018
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Studies of the comparative clinical outcomes between statin with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in ST-segment elevation myocardial infarction (STEMI) patients are limited. We compared 2-year clinical outcomes between statin with ACEI or ARB therapy in STEMI patients after successful percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Methods: A total of 11, 706 STEMI patients were enrolled and separated into two groups: the ACEI group (statin + ACEI, n = 8705) and the ARB group (statin + ARB, n = 3001). The primary endpoint was major adverse cardiac events (MACE) defined as all-cause death, recurrent MI (re-MI), and any coronary revascularization. Secondary endpoints were the individual components of MACE and target vessel failure (TVF). Results: After propensity score-matched (PSM) analysis, two PSM groups (2729 pairs, n = 5458, C-statistic = 0.675) were generated. The cumulative incidences of MACE, re-MI, and any coronary revascularization were similar between the two groups. However, the cumulative incidences of all-cause death (hazard ratio [HR], 1.548; 95% confidence interval [CI], 1.091–2.197; p = 0.014) and cardiac death (HR, 1.850; 95% CI, 1.218–2.811; p = 0.004) were significantly higher in the ARB group compared with the ACEI group after PSM analysis. Conclusions: The combination of statin with ACEI may be the preferred treatment strategy to reduce mortality rates in STEMI patients after successful PCI with DES rather than statin with ARB in this study during a 2-year follow-up period. Graphical abstract: Image 1 Highlights: The beneficial roles of statin and ACEI/ARB in STEMI patients are well-known. It is not known which is the better therapy between statin with ACEI or statin with ARB combination. Statin with ACEI is better than statin with ARB in reducing mortality rate. MACE, MI, and revascularization rates are similar between these two groups.