open access

Ahead of print
Research paper
Published online: 2020-03-18
Get Citation

Monotherapy versus combination therapy of statin and renin–angiotensin system inhibitor in ST-segment elevation myocardial infarction

Yong Hoon Kim, Ae-Young Her, Myung-Ho Jeong, Byeong-Keuk Kim, Sung-Jin Hong, Seunghwan Kim, Chul-Min Ahn, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang
DOI: 10.5603/CJ.a2020.0035
·
Pubmed: 32207841

open access

Ahead of print
Original articles
Published online: 2020-03-18

Abstract

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.

Abstract

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.

Get Citation

Keywords

ST-segment elevation Myocardial infarction, statin, renin–angiotensin system, long-term outcome

About this article
Title

Monotherapy versus combination therapy of statin and renin–angiotensin system inhibitor in ST-segment elevation myocardial infarction

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2020-03-18

DOI

10.5603/CJ.a2020.0035

Pubmed

32207841

Keywords

ST-segment elevation Myocardial infarction
statin
renin–angiotensin system
long-term outcome

Authors

Yong Hoon Kim
Ae-Young Her
Myung-Ho Jeong
Byeong-Keuk Kim
Sung-Jin Hong
Seunghwan Kim
Chul-Min Ahn
Jung-Sun Kim
Young-Guk Ko
Donghoon Choi
Myeong-Ki Hong
Yangsoo Jang

References (26)
  1. Hobbs FD, Banach M, Mikhailidis DP, et al. Is statin-modified reduction in lipids the most important preventive therapy for cardiovascular disease? A pro/con debate. BMC Med. 2016; 14: 4.
  2. Taylor FC, Huffman M, Ebrahim S. Statin therapy for primary prevention of cardiovascular disease. JAMA. 2013; 310(22): 2451–2452.
  3. Baigent C, Keech A, Kearney PM, et al. Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005; 366(9493): 1267–1278.
  4. Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
  5. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 61(4): e78–e7e140.
  6. Kim YH, Her AY, Jeong MHo, et al. Impact of renin-angiotensin system inhibitors on long-term clinical outcomes in patients with acute myocardial infarction treated with successful percutaneous coronary intervention with drug-eluting stents: Comparison between STEMI and NSTEMI. Atherosclerosis. 2019; 280: 166–173.
  7. Kim Y, Ahn Y, Cho MC, et al. Current status of acute myocardial infarction in Korea. Korean J Intern Med. 2019; 34(1): 1–10.
  8. Grech ED. ABC of interventional cardiology: percutaneous coronary intervention. II: the procedure. BMJ. 2003; 326(7399): 1137–1140.
  9. Athyros VG, Kakafika AI, Tziomalos K, et al. Pleiotropic effects of statins--clinical evidence. Curr Pharm Des. 2009; 15(5): 479–489.
  10. Larsen AI, Tomey MI, Mehran R, et al. Comparison of outcomes in patients with ST-segment elevation myocardial infarction discharged on versus not on statin therapy (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trial). Am J Cardiol. 2014; 113(8): 1273–1279.
  11. McMurray JJV, Pfeffer MA, Swedberg K, et al. Which inhibitor of the renin-angiotensin system should be used in chronic heart failure and acute myocardial infarction? Circulation. 2004; 110(20): 3281–3288.
  12. Messerli FH, Bangalore S. Angiotensin receptor blockers reduce cardiovascular events, including the risk of myocardial infarction. Circulation. 2017; 135(22): 2085–2087.
  13. Cheng J, Zhang W, Zhang X, et al. Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis. JAMA Intern Med. 2014; 174(5): 773–785.
  14. Zhang X, Xie YW, Nasjletti A, et al. ACE inhibitors promote nitric oxide accumulation to modulate myocardial oxygen consumption. Circulation. 1997; 95(1): 176–182.
  15. Laufs U, La Fa, Plutzky J, et al. Upregulation of endothelial nitric oxide synthase by HMG CoA reductase inhibitors. Circulation. 1998; 97(12): 1129–1135.
  16. Probstfield JL, O'Brien KD. Progression of cardiovascular damage: the role of renin-angiotensin system blockade. Am J Cardiol. 2010; 105(1 Suppl): 10A–20A.
  17. Lee HY, Sakuma I, Ihm SH, et al. Statins and renin-angiotensin system inhibitor combination treatment to prevent cardiovascular disease. Circ J. 2014; 78(2): 281–287.
  18. Athyros VG, Mikhailidis DP, Papageorgiou AA, et al. GREACE Study Collaborative Group. Effect of statins and ACE inhibitors alone and in combination on clinical outcome in patients with coronary heart disease. J Hum Hypertens. 2004; 18(11): 781–788.
  19. Li Z, Iwai M, Wu L, et al. Fluvastatin enhances the inhibitory effects of a selective AT1 receptor blocker, valsartan, on atherosclerosis. Hypertension. 2004; 44(5): 758–763.
  20. Athyros VG, Katsiki N, Karagiannis A, et al. Combination of statin plus renin angiotensin system inhibition for the prevention or the treatment of atherosclerotic cardiovascular disease. Curr Pharm Des. 2014; 20(40): 6299–6305.
  21. Pfeffer MA, McMurray J, Leizorovicz A, et al. Valsartan in acute myocardial infarction trial (VALIANT): rationale and design. Am Heart J. 2000; 140(5): 727–750.
  22. Cleland JG, Erhardt L, Murray G, et al. Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure. A report from the AIRE Study Investigators. Eur Heart J. 1997; 18(1): 41–51.
  23. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA) Early statin treatment following acute myocardial infarction and 1-year survival. JAMA. 2001; 285(4): 430–436.
  24. Koh KK, Quon MJ, Han SH, et al. Additive beneficial effects of losartan combined with simvastatin in the treatment of hypercholesterolemic, hypertensive patients. Circulation. 2004; 110(24): 3687–3692.
  25. Fox KM. EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). The Lancet. 2003; 362(9386): 782–788.
  26. Yusuf S, Sleight P, Pogue J, et al. Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000; 342(3): 145–153.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl