The Impact of RAS Inhibitor Uses on Clinical Outcomes by GRACE Score in STEMI Patients Who Underwent Successful PCI With Drug-Eluting Stents

초록

BACKGROUND In patients with ST-elevation myocardial infarction (STEMI), optimal medical treatment (OMT), such as beta-blockers, statins, and renin-angiotensin system (RAS) inhibitors, is emphasized to prevent recurrent cardiovascular events. The purpose of study is to evaluate the long-term clinical outcomes of RAS inhibitors by assessing the 6-month risk of death in each individual STEMI survivor. METHOD Of total 13,104 patients were enrolled in the Korean AMI registry, and a final 5,261 patients with STEMI had been clinical follow-ups. The 6-month mortality risk assessment, the GRACE score was calculated, and the cut-off for the low-risk death group was 100 points or less. There were 2,387 patients in the GRACE100 group and 2,874 patients in the GRACE>100 group. To adjust for confounding variables, propensity score matching (PSM) analysis was performed according to the uses of RAS inhibitors in each group. RESULTS Compared to the GRACE>100 groups, the GRACE<100 groups had a significantly lower mortality rate (P<0.001) of 0.4% vs. 2.7% at six months, 0.6% vs. 4.1% at 1-year, and 1.2% vs.9.1% at 3-year. After PSM analysis. In the GRACE<100 group, the use of RAS inhibitors did not make a difference in all clinical outcomes up to 3 years. In the GRACE>100 groups, the use of RAS inhibitors reduced cardiac death up to 3 years; 6 months (1.3% vs 3.8%, P<0.001), 1-year (2.0%vs4.8%, P<0.001), 3-years (4.9% vs 8.3%, P<0.001). CONCLUSION Our results suggest that recommendations, such as the use of the Grace score, are needed for clinicians to rule out OMT in clinical practice.