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Two-year clinical outcomes between statin with ACE inhibitor or ARB in patients with ST-segment elevation myocardial infarction after successful PCI with DES

Session Poster Session 1

Speaker Yong Hoon Kim

Event : ESC Congress 2019

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

Authors : YH Kim (Chuncheon,KR), A-Y Her (Chuncheon,KR), M-H Jeong (Gwangju,KR), B-K Kim (Seoul,KR), S-Y Lee (Gunpo,KR), S-J Hong (Seoul,KR), D-H Shin (Seoul,KR), C-M Ahn (Seoul,KR), J-S Kim (Seoul,KR), Y-G Ko (Seoul,KR), D Choi (Seoul,KR), M-K Hong (Seoul,KR), Y Jang (Seoul,KR)

Authors:
YH Kim1 , A-Y Her1 , M-H Jeong2 , B-K Kim3 , S-Y Lee4 , S-J Hong3 , D-H Shin3 , C-M Ahn3 , J-S Kim3 , Y-G Ko3 , D Choi3 , M-K Hong3 , Y Jang3 , 1Kangwon National University School of Medicine - Chuncheon - Korea (Republic of) , 2Chonnam National University Hospital, Department of Cardiology - Gwangju - Korea (Republic of) , 3Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine - Seoul - Korea (Republic of) , 4Sanbon Hospital, Wonkwang University College of Medicine, Department of Cardiology - Gunpo - Korea (Republic of) ,

Citation:

Background: Limited comparative data are available.

Purpose: We decided to compare 2-year major clinical outcomes between statin with ACEI and statin ARB therapy in patients with STEMI after PCI with drug-eluting stents (DES).

Methods: A total 11706 STEMI patients who underwent PCI with DES and who prescribed statin were enrolled and they were divided into two groups, the statin with ACEI group (n = 8705) and the statin with ARB group (n=3001). The primary endpoint was the major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-TVR. The secondary endpoints were the cumulative incidences of individual components of MACE and target vessel failure (TVF), a composite of death related to the target vessel, re-MI, or clinically driven TVR.

Results: Two PSM groups (2835 pairs, n = 5670, C-statistic = 0.680) were generated. The relative risk of MACE was higher in the statin with ARB group compared to statin with ACEI groups after propensity score-matched (PSM) analysis (hazard ratio [HR]: 1.323, 95% confidence interval [CI]: 1.085–1.613, p=0.006). The relative risks of cardiac death (HR: 1.831, 95% CI: 1.199–2.740, p=0.005), total repeat revascularization (HR: 1.487, 95% CI: 1.133–1.950, p=0.004), and non-TVR (HR: 1.696, 95% CI: 1.122–2.564, p=0.012) were also higher in the statin with ARB group after PSM.

Conclusions: In this study, we suggest that the combination of statin with ACEI may be beneficial for reducing the cumulative incidences of MACE, total repeat revascularization rate, and non-TVR rather than the statin with ARB after PCI with DES in STEMI patients.

Cumulative Events at 2-year (%)

Outcomes

Statin + ACEI

Statin + ARB

Log-rank

Hazard Ratio (95% CI)

p value

Propensity score matched Patients

MACE

173 (6.5)

225 (8.5)

0.006

1.323 (1.085 - 1.613)

0.006

All-cause death

58 (2.2)

80 (3.0)

0.054

1.391 (0.992 - 1.950)

0.056

Cardiac death

35 (1.3)

63 (2.3)

0.004

1.831 (1.199 - 2.740)

0.005

Re-MI

39 (1.5)

44 (1.7)

0.548

1.141 (0.742 - 1.756)

0.548

Total repeat revascularization

88 (3.4)

128 (4.9)

0.004

1.487 (1.133 - 1.950)

0.004

TLR

26 (1.0)

40 (1.5)

0.075

1.561 (0.953 - 2.558)

0.077

TVR

53 (2.0)

71 (2.8)

0.086

1.364 (0.955 - 1.946)

0.088

Non-TVR

36 (1.4)

60 (2.3)

0.011

1.696 (1.122 - 2.564)

0.012

TVF

140 (5.3)

173 (6.6)

0.050

1.249 (1.000 - 1.561)

0.050

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