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

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 2-year 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 groups (5891 pairs, n = 11,782, 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 0.983-1.749; 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.