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新型药物洗脱支架成功植入后急性心肌梗死后合并糖尿病前期患者中血管紧张素转换酶抑制剂与血管紧张素 II 型 1 受体阻滞剂的比较

Angiotensin converting enzyme inhibitors versus angiotensin II type 1 receptor blockers in patients with acute myocardial infarction and prediabetes after successful implantation of newer-generation drug-eluting stents.

机构信息

Division of Cardiology, Department of Inter nal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.

Department of Cardiology, Cardiovascular Center, Chonnam National Univer sity Hospital, Gwangju, Republic of Korea.

出版信息

Cardiol J. 2023;30(4):614-626. doi: 10.5603/CJ.a2021.0116. Epub 2021 Oct 8.

DOI:10.5603/CJ.a2021.0116

PMID:34622435

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10508070/

Abstract

BACKGROUND

Because limited data are available, the present study investigated 2-year major clinical outcomes after angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) therapy in patients with acute myocardial infarction (AMI) and prediabetes after successful implantation of newer-generation drug-eluting stents (DESs).

METHODS

Overall, 2932 patients with AMI and prediabetes were classified into two groups - the ACEIs group (n = 2059) and the ARBs group (n = 873). The primary endpoint was the occurrence of patient- -oriented composite outcome (POCO), defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat revascularization. The secondary endpoint was definite or probable stent thrombosis (ST).

RESULTS

The cumulative incidences of POCO (adjusted hazard ratio [aHR]: 1.020; 95% confidence interval [CI]: 0.740-1.404; p = 0.906), all-cause death (aHR: 1.394; 95% CI: 0.803-2.419; p = 0.238), Re-MI (aHR: 1.210; 95% CI: 0.626-2.340; p = 0.570), any repeat revascularization (aHR: 1.150; 95% CI: 0.713-1.855; p = 0.568), and ST (aHR: 1.736; 95% CI: 0.445-6.766; p = 0.427) were similar between the groups. These results were confirmed after propensity score-adjusted analysis.

CONCLUSIONS

In this study, patients with AMI and prediabetes who received ACEIs or ARBs showed comparable clinical outcomes during the 2-year follow-up period.

摘要

背景

由于数据有限，本研究调查了在成功植入新一代药物洗脱支架（DES）后，急性心肌梗死（AMI）合并糖尿病前期患者使用血管紧张素转换酶抑制剂（ACEI）和血管紧张素 II 型 1 型受体阻滞剂（ARB）治疗 2 年后的主要临床结局。

方法

共有 2932 例 AMI 合并糖尿病前期患者分为 ACEI 组（n=2059）和 ARB 组（n=873）。主要终点是患者导向的复合结局（POCO）的发生，定义为全因死亡、再发心肌梗死（Re-MI）或任何再次血运重建。次要终点是确定或可能的支架血栓形成（ST）。

结果

POCO 的累积发生率（调整后的危险比[aHR]：1.020；95%置信区间[CI]：0.740-1.404；p=0.906）、全因死亡（aHR：1.394；95% CI：0.803-2.419；p=0.238）、Re-MI（aHR：1.210；95% CI：0.626-2.340；p=0.570）、任何再次血运重建（aHR：1.150；95% CI：0.713-1.855；p=0.568）和 ST（aHR：1.736；95% CI：0.445-6.766；p=0.427）在两组之间相似。这些结果在倾向评分调整分析后得到证实。