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. 2022;29(1):93-104.
doi: 10.5603/CJ.a2020.0035. Epub 2020 Mar 24.

Monotherapy versus combination therapy of statin and renin-angiotensin system inhibitor in ST-segment elevation myocardial infarction

Yong Hoon Kim  1 , Ae-Young Her  2 , Myung-Ho Jeong  3 , Byeong-Keuk Kim  4 , Sung-Jin Hong  4 , Seunghwan Kim  5 , Chul-Min Ahn  4 , Jung-Sun Kim  4 , Young-Guk Ko  4 , Donghoon Choi  4 , Myeong-Ki Hong  4 , Yangsoo Jang  4
Affiliations

Monotherapy versus combination therapy of statin and renin-angiotensin system inhibitor in ST-segment elevation myocardial infarction

Yong Hoon Kim et al. Cardiol J. 2022.

Abstract

Background: The beneficial effects of statin and renin-angiotensin system inhibitor (RASI) are well-known. In this retrospective cohort study, 2-year clinical outcomes were compared between monotherapy and combination therapy with statin and RASI in ST-segment elevation myocardial infarction (STEMI) patients after stent implantation.

Methods: A total of 17,414 STEMI patients were enrolled and divided into the three groups (group A: 2448 patients, statin alone; group B: 2431 patients, RASI alone; and group C: 12,535 patients, both statin and RASI). The principal clinical endpoint was the occurrence of major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction, and any repeat revascularization.

Results: After adjustment, the cumulative incidences of MACEs in group A (adjusted hazard ratio [aHR] 1.337; 95% confidence interval [CI] 1.064-1.679; p = 0.013) and in group B (aHR 1.375; 95% CI 1.149-1.646; p = 0.001) were significantly higher than in group C. The cumulative incidence of all-cause death in group A was significantly higher than that in group C (aHR 1.539; 95% CI 1.014-2.336; p = 0.043). The cumulative incidences of any repeat revascularization (aHR 1.317; 95% CI 1.031-1.681; p = 0.028), target lesion vascularization, and target vessel vascularization in group B were significantly higher than in group C.

Conclusions: A statin and RASI combination therapy significantly reduced the cumulative incidence of MACEs compared with a monotherapy of these drugs. Moreover, the combination therapy showed a reduced all-cause death rate compared with statin monotherapy, and a decreased repeat revascularization rate compared with RASI monotherapy.

Keywords: ST-segment elevation myocardial infarction; long-term outcome; renin–angiotensin system; statin.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Flow chart; KAMIR — Korea Acute myocardial Infarction Registry; STEMI — ST-segment elevation myocardial infarction; RASI — renin–angiotensin system inhibitor.
Figure 2
Figure 2
Kaplan-Meier curved analysis for major adverse cardiac events (MACEs; A), all-cause death (B), recurrent myocardial infarction (Re-MI; C), any repeat revascularization (D), target lesion revascularization (TLR; E), and target vessel revascularization (TVR; F) during a 2-year follow-up perioad d; aHR — adjusted hazard ratio.
See this image and copyright information in PMC

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