Why the study?
While the benefits of statin and renin-angiotensin system inhibitor are well known, clinical outcomes comparing monotherapy versus combination therapy in STEMI patients after stent implantation needed evaluation.
Does combination therapy with a statin and a renin-angiotensin system inhibitor reduce major adverse cardiac events in STEMI patients after stent implantation compared to monotherapy with either drug?
Does combination therapy with a statin and a renin-angiotensin system inhibitor reduce major adverse cardiac events in STEMI patients after stent implantation compared to monotherapy with either drug?
Combination therapy with a statin and a renin-angiotensin system inhibitor significantly reduces the 2-year risk of major adverse cardiac events in STEMI patients after stent implantation compared to monotherapy with either agent.
May support combination statin-RASI therapy post-STEMI stenting; leaves open need for randomized confirmation.
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.
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Kim et al. (2020) studied this question.
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