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Comparison Between Beta-Blockers with Angiotensin-Converting Enzyme Inhibitors and Beta-Blockers with Angiotensin II Type I Receptor Blockers in ST-Segment Elevation Myocardial Infarction After Successful Percutaneous Coronary Intervention with Drug-Eluting Stents

  • Yong Hoon KimEmail author
  • Ae-Young Her
  • Myung Ho Jeong
  • Byeong-Keuk Kim
  • Seung-Yul Lee
  • Sung-Jin Hong
  • Dong-Ho Shin
  • Jung-Sun Kim
  • Young-Guk Ko
  • Donghoon Choi
  • Myeong-Ki Hong
  • Yangsoo Jang
ORIGINAL ARTICLE
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Abstract

Background/Aims

Limited comparative data concerning long-term clinical outcomes of combination therapy between beta-blockers (BB) with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) therapy in patients with ST-segment elevation myocardial infarction (STEMI) are available. We thought to compare 2-year major clinical outcomes between BB with ACEI and BB with ARB therapy in patients with STEMI after successful percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

Methods

13,873 STEMI patients who underwent successful PCI with DES were enrolled and divided into two groups as the BB with ACEI group (n = 10,393) and the BB with ARB group (n = 3480). 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 the 2-year follow-up period.

Results

After propensity score-matched (PSM) analysis, two PSM groups (3296 pairs, n = 6592, C-statistic = 0.675) were generated. Although the incidences of re-MI, TLR, and TVR were similar, the incidences of MACE (8.3% vs. 6.8%, log-rank p = 0.038, hazard ratio [HR] 1.210, 95% confidence interval [CI] 1.010–1.451, p = 0.039), all-cause death, CD, total revascularization, and non-TVR of the BB with ARB group were significantly higher than the BB with ACEI group after PSM. In addition, diabetes and multivessel disease were significant predictors for non-TVR.

Conclusions

The combination BB with ACEI may be beneficial for reducing MACE in STEMI patients after successful PCI with DES than the BB with ARB.

Keywords

Myocardial infarction Beta-blocker Angiotensin-converting enzyme inhibitor Angiotensin receptor blocker 

Abbreviations

AMI

Acute myocardial infarction

STEMI

ST-segment elevation myocardial infarction

DES

Drug-eluting stent

EES

Everolimus-eluting stent

MACE

Major adverse cardiac event

PCI

Percutaneous coronary intervention

PES

Paclitaxel-eluting stent

SES

Sirolimus-eluting stent

TLR

Target lesion revascularization

TVR

Target vessel revascularization

Non-TVR

Non-target vessel revascularization

ZES

Zotarolimu-eluting stent

Notes

Acknowledgements

Korea Acute Myocardial infarction Registry (KAMIR) investigators.

Myung Ho Jeong, MD; Youngkeun Ahn, MD; Sung Chul Chae, MD; Jong Hyun Kim, MD; Seung-Ho Hur, MD; Young Jo Kim, MD; In Whan Seong, MD; Donghoon Choi, MD; Jei Keon Chae, MD; Taek Jong Hong, MD; Jae Young Rhew, MD; Doo-Il Kim, MD; In-Ho Chae, MD; Jung Han Yoon, MD; Bon-Kwon Koo, MD; Byung-Ok Kim, MD; Myoung Yong Lee, MD; Kee-Sik Kim, MD; Jin-Yong Hwang, MD; Myeong Chan Cho, MD; Seok Kyu Oh, MD; Nae-Hee Lee, MD; Kyoung Tae Jeong, MD; Seung-Jea Tahk, MD; Jang-Ho Bae, MD; Seung-Woon Rha, MD; Keum-Soo Park, MD; Chong Jin Kim, MD; Kyoo-Rok Han, MD; Tae Hoon Ahn, MD; Moo-Hyun Kim, MD; Ki Bae Seung, MD; Wook Sung Chung, MD; Ju-Young Yang, MD; Chong Yun Rhim, MD; Hyeon-Cheol Gwon, MD; Seong-Wook Park, MD; Young-Youp Koh, MD; Seung Jae Joo, MD; Soo-Joong Kim, MD; Dong Kyu Jin, MD; Jin Man Cho, MD; Sang-Wook Kim, MD; Jeong Kyung Kim, MD; Tae Ik Kim, MD; Deug Young Nah, MD; Si Hoon Park, MD; Sang Hyun Lee, MD; Seung Uk Lee, MD; Hang-Jae Chung, MD; Jang-Hyun Cho, MD; Seung Won Jin, MD; Myeong-Ki Hong, MD; Yangsoo Jang, MD; Jeong Gwan Cho, MD; Hyo-Soo Kim, MD; and Seung Jung Park, MD.

Funding

This research was supported by a fund (2016-ER6304-02) by Research of Korea Centers for Disease Control and Prevention.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Yong Hoon Kim
    • 1
    Email author return OK on get
  • Ae-Young Her
    • 1
  • Myung Ho Jeong
    • 2
  • Byeong-Keuk Kim
    • 3
  • Seung-Yul Lee
    • 4
  • Sung-Jin Hong
    • 3
  • Dong-Ho Shin
    • 3
  • Jung-Sun Kim
    • 3
  • Young-Guk Ko
    • 3
  • Donghoon Choi
    • 3
  • Myeong-Ki Hong
    • 3
  • Yangsoo Jang
    • 3
  1. 1.Division of Cardiology, Department of Internal MedicineKangwon National University School of MedicineChuncheonSouth Korea
  2. 2.Chonnam National University HospitalGwangjuSouth Korea
  3. 3.Division of Cardiology, Severance Cardiovascular Hospital, College of MedicineYonsei UniversitySeoulSouth Korea
  4. 4.Sanbon Hospital, College of MedicineWonkwang UniversityGunpoSouth Korea

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