Key result
BB and RASI linked to lower MACE in AMI, despite ~66% higher recurrent MI in diabetes.
Why the study?
Data on long-term clinical outcomes are limited for patients with AMI and prediabetes or diabetes receiving BB and RASI therapy following newer-generation DES implantation.
Does beta-blocker and renin-angiotensin system inhibitor combination therapy reduce major adverse cardiac events in patients with acute myocardial infarction and prediabetes or diabetes who underwent successful drug-eluting stent implantation?
Observational (n=9,466)
Yes
Does beta-blocker and renin-angiotensin system inhibitor combination therapy reduce major adverse cardiac events in patients with acute myocardial infarction and prediabetes or diabetes who underwent successful drug-eluting stent implantation?
Combination therapy with beta-blockers and renin-angiotensin system inhibitors is associated with reduced MACEs and heart failure hospitalizations in AMI patients post-DES implantation, regardless of glycemic status.
Long-term clinical outcomes in patients with acute myocardial infarction (AMI) and prediabetes or diabetes who received ß-blockers (BB) and renin–angiotensin system inhibitor (RASI) therapy after successful newer-generation drug-eluting stent (DES) implantation are limited. We compared the two-year clinical outcomes in such patients. A total of 9466 patients with AMI in the Korea AMI Registry were classified into six groups according to their glycemic status and presence or absence of BB + RASI therapy: normoglycemia and BB + RASI users (n = 2217) or nonusers (n = 243), prediabetes and BB + RASI users (n = 2601) or nonusers (n = 306), and diabetes and BB + RASI users (n = 3682) or nonusers (n = 417). The primary endpoint was major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat revascularization, and the secondary endpoint was the cumulative incidence of hospitalization for heart failure (HHF). In patients with BB + RASI, despite similar primary and secondary clinical points between the prediabetes and diabetes groups, the cumulative incidence of Re-MI (adjusted hazard ratio: 1.660; 95% confidence interval: 1.000–2.755; p = 0.020) was higher in the diabetes group than in the prediabetes group. In all three different glycemic groups, BB + RASI users showed reduced MACEs, cardiac death, and HHF compared to those of BB + RASI nonusers. In this retrospective observational registry study, BB + RASI therapy showed comparable clinical outcomes except for Re-MI between prediabetes and diabetes in patients with AMI during a two-year follow-up period.
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Kim et al. (2020) conducted an observational in Acute myocardial infarction and prediabetes or diabetes (n=9,466). ß-blockers (BB) and renin-angiotensin system inhibitor (RASI) therapy vs. BB + RASI nonusers was evaluated on major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat revascularization. BB and RASI combination therapy reduced MACEs compared to nonusers in AMI patients across all glycemic groups, though recurrent MI risk was higher in diabetes vs prediabetes (HR 1.660; P=0.020).
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