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 aimsWe 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. MethodsA 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. ResultsAfter 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. ConclusionsThe mortality reduction capability of RASI was more prominent in the STEMI patients compared with the NSTEMI patients.