Impact of renin-angiotensin system inhibitors on long-term clinical outcomes in patients with acute myocardial infarction treated with successful percutaneous coronary intervention with drug-eluting stents: Comparison between STEMI and NSTEMI

Yong Hoon Kim, Ae Young Her, Myung Ho Jeong, Byeong Keuk Kim, Seung Yul Lee, Sung Jin Hong, Dong Ho Shin, Jung Sun Kim, Young Guk Ko, Donghoon Choi, Myeongki Hong, Yangsoo Jang

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)166-173
Number of pages8
JournalAtherosclerosis
Volume280
DOIs
Publication statusPublished - 2019 Jan 1

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Drug-Eluting Stents
Percutaneous Coronary Intervention
Renin-Angiotensin System
Myocardial Infarction
Cause of Death
Propensity Score
Confidence Intervals
Cardiogenic Shock
Cardiopulmonary Resuscitation
Creatine Kinase
Stroke Volume
Isoenzymes
Research Design
Hypertension
Mortality
ST Elevation Myocardial Infarction
Non-ST Elevated Myocardial Infarction
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{a46189f0dd5c4968992cbb7fd4d645bb,
title = "Impact of renin-angiotensin system inhibitors on long-term clinical outcomes in patients with acute myocardial infarction treated with successful percutaneous coronary intervention with drug-eluting stents: Comparison between STEMI and NSTEMI",
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.",
author = "Kim, {Yong Hoon} and Her, {Ae Young} and Jeong, {Myung Ho} and Kim, {Byeong Keuk} and Lee, {Seung Yul} and Hong, {Sung Jin} and Shin, {Dong Ho} and Kim, {Jung Sun} and Ko, {Young Guk} and Donghoon Choi and Myeongki Hong and Yangsoo Jang",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.atherosclerosis.2018.11.030",
language = "English",
volume = "280",
pages = "166--173",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

Impact of renin-angiotensin system inhibitors on long-term clinical outcomes in patients with acute myocardial infarction treated with successful percutaneous coronary intervention with drug-eluting stents : Comparison between STEMI and NSTEMI. / Kim, Yong Hoon; Her, Ae Young; Jeong, Myung Ho; Kim, Byeong Keuk; Lee, Seung Yul; Hong, Sung Jin; Shin, Dong Ho; Kim, Jung Sun; Ko, Young Guk; Choi, Donghoon; Hong, Myeongki; Jang, Yangsoo.

In: Atherosclerosis, Vol. 280, 01.01.2019, p. 166-173.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of renin-angiotensin system inhibitors on long-term clinical outcomes in patients with acute myocardial infarction treated with successful percutaneous coronary intervention with drug-eluting stents

T2 - Comparison between STEMI and NSTEMI

AU - Kim, Yong Hoon

AU - Her, Ae Young

AU - Jeong, Myung Ho

AU - Kim, Byeong Keuk

AU - Lee, Seung Yul

AU - Hong, Sung Jin

AU - Shin, Dong Ho

AU - Kim, Jung Sun

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Hong, Myeongki

AU - Jang, Yangsoo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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U2 - 10.1016/j.atherosclerosis.2018.11.030

DO - 10.1016/j.atherosclerosis.2018.11.030

M3 - Article

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AN - SCOPUS:85057846740

VL - 280

SP - 166

EP - 173

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -