Key result
Statin and RASI use links to similar MACE but lower mortality in STEMI versus NSTEMI.
Why the study?
Limited data were available comparing the combined effects of statins and renin-angiotensin system inhibitors between patients with STEMI and those with NSTEMI.
Does statin with RASI combination therapy have different effects on clinical outcomes in STEMI compared to NSTEMI patients after stent implantation?
Cohort (n=21,890)
Yes
Does statin with RASI combination therapy have different effects on clinical outcomes in STEMI compared to NSTEMI patients after stent implantation?
In AMI patients undergoing stent implantation, statin and RASI combination therapy was associated with lower risks of all-cause and cardiac death in STEMI patients compared to NSTEMI patients.
Answers are grounded in this paper and cite their sources.
Statin-RASI combination should not yet guide differential prescribing by AMI type; leaves open mortality differences for randomized confirmation.
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 long-term 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 (PSM) groups (5891 pairs, n = 11782, 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 1.983-1.749; 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.
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Kim et al. (2021) conducted a cohort in Acute myocardial infarction (AMI) post-stent implantation (n=21,890). Statin and renin-angiotensin system inhibitor (RASI) combination therapy in STEMI vs. Statin and RASI combination therapy in NSTEMI was evaluated on Major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction, and any repeat revascularization (HR 1.108, 95% CI 0.969-1.266, p=0.132). Statin and RASI combination therapy resulted in similar rates of major adverse cardiac events between STEMI and NSTEMI patients, but was associated with significantly lower all-cause death in the STEMI group.
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