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. 2022;29(4):647-659.
doi: 10.5603/CJ.a2021.0007. Epub 2021 Feb 26.

ST-elevation versus non-ST-elevation myocardial infarction after combined use of statin with renin-angiotensin system inhibitor: Data from the Korea Acute Myocardial Infarction Registry

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

ST-elevation versus non-ST-elevation myocardial infarction after combined use of statin with renin-angiotensin system inhibitor: Data from the Korea Acute Myocardial Infarction Registry

Yong Hoon Kim et al. Cardiol J. 2022.

Abstract

Background: Limited data are available comparing the combined effects of statins and renin-angiotensin system inhibitor (RASI) between patients with ST-segment elevation myocardial infarction (STEMI) and those with non-STEMI (NSTEMI). We compared the effects of statins combined with RASI in STEMI and NSTEMI patients after stent implantation during a long-term follow-up period.

Methods: A total of 21,890 acute myocardial infarction (AMI) patients who underwent successful stent implantation and who received statins with RASI were enrolled. They were separated into the STEMI group (n = 12,490) and the NSTEMI group (n = 9400). The major clinical endpoint was the occurrence of major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization.

Results: Two propensity score-matched (PSM) groups (5891 pairs, n = 11782, C-statistic = 0.821) were generated. Even though the cumulative incidences of MACE, re-MI, total repeat revascularization were similar between the two groups, the cumulative incidences of all-cause death (hazard ratio [HR] 1.407; 95% confidence interval [CI] 1.106-1.790; p = 0.005) and cardiac death (HR 1.311; 95% CI 1.983-1.749; p = 0.046) were significantly higher in the NSTEMI group.

Conclusions: In this study, statin with RASI combination therapy was more beneficial to the STEMI patients than to the NSTEMI patients in reducing all-cause death and cardiac death.

Keywords: ST-segment elevation myocardial infarction; non-ST-segment elevation myocardial infarction; renin–angiotensin system; statin.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Flow chart; AMI — acute myocardial infarction; KAMIR — Korea Acute Myocardial Infarction Registry; NSTEMI — non-ST-segment elevation myocardial infarction; RASI — renin–angiotensin system inhibitor; STEMI — ST-segment elevation myocardial infarction.
Figure 2
Figure 2
Kaplan-Meier analysis for major adverse cardiac events (MACEs) (A, B), all-cause death (C), and cardiac death (D); PSM — propensity score-matched; HR — hazard ratio; CI — confidence interval; NSTEMI — non-ST-segment elevation myocardial infarction; STEMI — ST-segment elevation myocardial infarction.
Figure 3
Figure 3
Subgroup analysis for major adverse cardiac events (MACEs); CI — confidence interval; NSTEMI — non-ST-segment elevation myocardial infarction; STEMI — ST-segment elevation myocardial infarction; LVEF — left ventricular ejection fraction; CPR — cardiopulmonary resuscitation; PCI — percutaneous coronary intervention; LAD — left anterior descending artery; ACE/AHA — American College of Cardiology/American Heart Association.
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