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Long term clinical benefit of renin angiotensin system inhibitor in non-myocardial infarction patients undergoing percutaneous coronary intervention

Session Poster session 1

Speaker Won Jik Lee

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : W J Lee (Seoul,KR), Y Choi (Seoul,KR), SM Lim (Bucheon,KR), JH Jang (Seoul,KR), SH Kim (Seoul,KR), BH Kim (Seoul,KR), KY Lee (Incheon,KR), MO Jang (Seoul,KR), YS Koh (Seoul,KR), HJ Park (Seoul,KR), PJ Kim (Seoul,KR), WS Jung (Seoul,KR), KB Seung (Seoul,KR), KY Jang (Seoul,KR)

W.J. Lee1 , Y. Choi1 , S.M. Lim2 , J.H. Jang1 , S.H. Kim1 , B.H. Kim1 , K.Y. Lee3 , M.O. Jang1 , Y.S. Koh1 , H.J. Park1 , P.J. Kim1 , W.S. Jung1 , K.B. Seung1 , K.Y. Jang1 , 1Seoul St. Mary's Hospital, Cardiovascular center and Cardiology Division - Seoul - Korea Republic of , 2Sejong General Hospital - Bucheon - Korea Republic of , 3St.Mary's Hospital, 2Division of Cardiology, Department of Internal Medicine - Incheon - Korea Republic of ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 185-186

Background: The benefit of renin-angiotensin system (RAS) inhibitor (angiotensin converting enzyme inhibitor or angiotensin receptor blocker) in non-myocardial infarction coronary heart disease is yet not established. Current study aimed to analyze the effect of RAS inhibitor on long term clinical outcome after percutaneous coronary intervention (PCI) in non-MI patients using real world registry.

Methods: All patients who underwent PCI using drug-eluting stents were prospectively enrolled in the Catholic University of Korea-PCI (COACT) registry. Patients presenting myocardial infarction (MI) or patients expired during index admission were excluded. A total of 6134 non-MI patients were divided into two groups by the presence of RAS inhibitor for discharge medication. The primary outcome was major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, non-fatal MI and stroke in 3 years. The secondary outcomes were all-cause death, target lesion revascularization (TLR) and any coronary revascularization.

Results: There were 4357 patients in RAS inhibitor group and 1777 in no RAS inhibitor group. Incidence of MACE was significantly lower in RAS inhibitor group (HR 0.672, 95% CI 0.542–0.834). All-cause death was reduced for RAS inhibitor group [HR 0.622 (95% CI 0.502–0.769), p<0.001], while incidence of TLR [HR 0.971 (95% CI 0.800–1.179)] and any coronary revascularization [HR 0.894 (95% CI 0.756–1.057)] were similar between two groups. Overall results were consistent in propensity score matched population [MACE: HR 0.670 (95% CI 0.509–0.882), all-cause death: HR 0.635 (95% CI 0.582–0.836].

Conclusion: Use of RAS inhibitor is associated with better long term cardiovascular outcome and survival benefit in non-MI patients undergoing PCI.

Figure 1

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