Chonnam Med J.  2016 May;52(2):128-135. 10.4068/cmj.2016.52.2.128.

Comparative Effects of Statin Therapy versus Renin-Angiotensin System Blocking Therapy in Patients with Ischemic Heart Failure Who Underwent Percutaneous Coronary Intervention

• Won J
• Hong YJ
• Jeong MH
• Park HJ
• Kim MC
• Kim WJ
• Kim HK
• Sim DS
• Kim JH
• Ahn Y
• Cho JG
• Park JC

• KMID: 2164324
• DOI: http://doi.org/10.4068/cmj.2016.52.2.128

Abstract

Statins and renin-angiotensin system (RAS) blockers are key drugs for treating patients with an acute myocardial infarction (AMI). This study was designed to show the association between treatment with statins or RAS blockers and clinical outcomes and the efficacy of two drug combination therapies in patients with ischemic heart failure (IHF) who underwent revascularization for an AMI. A total of 804 AMI patients with a left ventricular ejection fraction <40% who undertook percutaneous coronary interventions (PCI) were analyzed using the Korea Acute Myocardial Infarction Registry (KAMIR). They were divided into four groups according to the use of medications [Group I: combination of statin and RAS blocker (n=611), Group II: statin alone (n=112), Group III: RAS blocker alone (n=53), Group IV: neither treatment (n=28)]. The cumulative incidence of major adverse cardiac and cerebrovascular events (MACCEs) and independent predictors of MACCEs were investigated. Over a median follow-up study of nearly 1 year, MACCEs had occurred in 48 patients (7.9%) in Group I, 16 patients (14.3%) in Group II, 3 patients (5.7%) in Group III, 7 patients (21.4%) in Group IV (p=0.013). Groups using RAS blocker (Group I and III) showed better clinical outcomes compared with the other groups. By multivariate analysis, use of RAS blockers was the most powerful independent predictor of MACCEs in patients with IHF who underwent PCI (odds ratio 0.469, 95% confidence interval 0.285-0.772; p=0.003), but statin therapy was not found to be an independent predictor. The use of RAS blockers, but not statins, was associated with better clinical outcomes in patients with IHF who underwent PCI.

Keyword

Myocardial Infarction; Heart failure; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Renin-Angiotensin System

MeSH Terms

Follow-Up Studies
Heart Failure*
Heart*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Incidence
Korea
Multivariate Analysis
Myocardial Infarction
Percutaneous Coronary Intervention*
Renin-Angiotensin System*
Stroke Volume
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Figure

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  FIG. 1 Study flow sheet. KAMIR: Korea Acute Myocardial Infarction Registry, CABG: coronary artery bypass graft, LVEF: left ventricular ejection fraction, RAS: renin-angiotensin system.

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  FIG. 2 Kaplan-Meier curve for MACCE-free survival of each groups at 24-month follow-up. MACCE: major adverse cardiac and cerebrovascular events.

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