Optimal Use Duration of Renin-Angiotensin-System Inhibitor Therapy for ST-Elevation Myocardial Infarction Patients

초록

BACKGROUND Renin-angiotensin-system inhibitor (RASI), including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are necessary for improving cardiovascular outcomes in patients with ST-elevation myocardial infarction (STEMI). However, there are various opinions about the optimal period of use of RASI therapy, particularly in patients whose cardiac function is relatively well preserved or improving following successful percutaneous coronary intervention (PCI). METHODS We analyzed data from the Korea Acute Myocardial Infarction Registry (KAMIR) involving 5,017 STEMI patients who underwent successful PCI. Patients were grouped based on RASI use (ACEI, ARB, or no RASI) and followed for up to 3 years. The primary endpoint was cardiac death, and secondary endpoints included major adverse cardiac events (MACE) and total mortality. To adjust baseline potential confounders, an inverse probability weighting (IPTW) analysis was performed. RESULTS In the first year, patients taking RASI have a better prognosis of cardiac death (2.8% vs. 5.7%, P < 0.001), MACE (13.3% vs. 16.8%, P ¼ 0.005), and total mortality (4.8% vs. 8.6%, P < 0.001) than those not taking RASI. After one year, although prescription of RASI switched from ACEI to ARB or discontinued, the effect of RASI therapy lasted for 3years. CONCLUSIONS The clinical prognosis of STEMI patients improved during the one-year period of RASI therapy, and this effect continued for three years even after the drug was changed or discontinued. Further research is needed to determine the optimal duration of RASI therapy in STEMI patients to improve clinical prognosis.