比较成功行经皮冠状动脉介入治疗药物洗脱支架后 ST 段抬高型心肌梗死患者中β受体阻滞剂联合血管紧张素转换酶抑制剂与β受体阻滞剂联合血管紧张素Ⅱ 1 型受体阻滞剂的疗效。
Comparison Between Beta-Blockers with Angiotensin-Converting Enzyme Inhibitors and Beta-Blockers with Angiotensin II Type I Receptor Blockers in ST-Segment Elevation Myocardial Infarction After Successful Percutaneous Coronary Intervention with Drug-Eluting Stents.
机构信息
Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, 24289, 156 Baengnyeong Road, Chuncheon, Gangwon Province, South Korea.
Chonnam National University Hospital, Gwangju, South Korea.
出版信息
Cardiovasc Drugs Ther. 2019 Feb;33(1):55-67. doi: 10.1007/s10557-018-6841-7.
BACKGROUND/AIMS: Limited comparative data concerning long-term clinical outcomes of combination therapy between beta-blockers (BB) with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) therapy in patients with ST-segment elevation myocardial infarction (STEMI) are available. We thought to compare 2-year major clinical outcomes between BB with ACEI and BB with ARB therapy in patients with STEMI after successful percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
METHODS
13,873 STEMI patients who underwent successful PCI with DES were enrolled and divided into two groups as the BB with ACEI group (n = 10,393) and the BB with ARB group (n = 3480). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, cardiac death (CD), recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during the 2-year follow-up period.
RESULTS
After propensity score-matched (PSM) analysis, two PSM groups (3296 pairs, n = 6592, C-statistic = 0.675) were generated. Although the incidences of re-MI, TLR, and TVR were similar, the incidences of MACE (8.3% vs. 6.8%, log-rank p = 0.038, hazard ratio [HR] 1.210, 95% confidence interval [CI] 1.010-1.451, p = 0.039), all-cause death, CD, total revascularization, and non-TVR of the BB with ARB group were significantly higher than the BB with ACEI group after PSM. In addition, diabetes and multivessel disease were significant predictors for non-TVR.
CONCLUSIONS
The combination BB with ACEI may be beneficial for reducing MACE in STEMI patients after successful PCI with DES than the BB with ARB.
背景/目的：关于在经皮冠状动脉介入治疗（PCI）置入药物洗脱支架（DES）后 ST 段抬高型心肌梗死（STEMI）患者中，β受体阻滞剂（BB）联合血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）治疗的长期临床结局的比较数据有限。我们认为，在成功接受 PCI 置入 DES 的 STEMI 患者中，与 BB 联合 ACEI 治疗相比，BB 联合 ARB 治疗的 2 年主要临床结局可能存在差异。
方法
共纳入 13873 例成功接受 PCI 置入 DES 的 STEMI 患者，并将其分为 BB 联合 ACEI 组（n=10393）和 BB 联合 ARB 组（n=3480）。主要临床终点是 2 年随访期间全因死亡、心脏性死亡（CD）、再发心肌梗死（re-MI）、总冠状动脉血运重建（TLR，靶病变血运重建[TVR]，非 TVR）组成的主要不良心脏事件（MACE）的发生情况。
结果
经倾向性评分匹配（PSM）分析后，生成了 2 个 PSM 组（3296 对，n=6592，C 统计量=0.675）。尽管 re-MI、TLR 和 TVR 的发生率相似，但 BB 联合 ARB 组的 MACE（8.3%比 6.8%，log-rank p=0.038，风险比[HR]1.210，95%置信区间[CI]1.010-1.451，p=0.039）、全因死亡、CD、总血运重建和非 TVR 的发生率均明显高于 BB 联合 ACEI 组。此外，糖尿病和多血管病变是非 TVR 的显著预测因素。
结论
与 BB 联合 ARB 相比，在成功接受 PCI 置入 DES 的 STEMI 患者中，BB 联合 ACEI 可能更有益于降低 MACE。
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