The Impact of Renin–Angiotensin System Inhibitor Use on Clinical Outcomes by GRACE Score in ST-elevation MI Patients Undergoing Successful Percutaneous Coronary Intervention with Drug-eluting Stents

Objectives:In patients with ST-elevation MI (STEMI), optimal medical treatment (OMT), such as β-blockers, statins and renin-angiotensin system (RAS) inhibitors, is emphasised to prevent recurrent cardiovascular events.The purpose of study was to evaluate the long-term clinical outcomes of RAS inhibitors by assessing the 6-month risk of death in each individual STEMI survivor. Materials and methods:In total, 13,104 patients were enrolled in the Korean AMI registry, and 5,261 patients with STEMI had undergone clinical follow-ups.The 6-month mortality risk assessment, the GRACE score, was calculated, and the cut-off for the low-risk death group was 100 points or less.There were 2,387 patients in the GRACE ≤100 group and 2,874 patients in the GRACE >100 group.To adjust for confounding variables, propensity score matching (PSM) analysis was performed according to the uses of RAS inhibitors in each group.Results: Compared to the GRACE >100 groups, the GRACE <100 groups had a significantly lower mortality rate (p<0.001) of 0.4% versus 2.7% at 6 months, 0.6% versus.4.1% at 1 year, and 1.2% versus 9.1% at 3 years after PSM analysis.In the GRACE <100 group, the use of RAS inhibitors did not make a difference in all clinical outcomes up to 3 years.In the GRACE >100 groups, the use of RAS inhibitors reduced cardiac death up to 3 years: 6 months (1.3% versus 3.8%, p<0.001), 1 year (2.0% versus 4.8%, p<0.001), 3 years (4.9% versus 8.3%, p<0.001). Conclusion:Our results suggest that recommendations, such as the use of the GRACE score, are needed for clinicians to rule out OMT in clinical practice.