Beta-Blocker and Renin–Angiotensin System Inhibitor Combination Therapy in Patients with Acute Myocardial Infarction and Prediabetes or Diabetes Who Underwent Successful Implantation of Newer-Generation Drug-Eluting Stents: A Retrospective Observational Registry Study

Abstract

Long-term clinical outcomes in patients with acute myocardial infarction (AMI) and prediabetes or diabetes who received ß-blockers (BB) and renin–angiotensin system inhibitor (RASI) therapy after successful newer-generation drug-eluting stent (DES) implantation are limited. We compared the two-year clinical outcomes in such patients. A total of 9466 patients with AMI in the Korea AMI Registry were classified into six groups according to their glycemic status and presence or absence of BB + RASI therapy: normoglycemia and BB + RASI users (n = 2217) or nonusers (n = 243), prediabetes and BB + RASI users (n = 2601) or nonusers (n = 306), and diabetes and BB + RASI users (n = 3682) or nonusers (n = 417). The primary endpoint was major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat revascularization, and the secondary endpoint was the cumulative incidence of hospitalization for heart failure (HHF). In patients with BB + RASI, despite similar primary and secondary clinical points between the prediabetes and diabetes groups, the cumulative incidence of Re-MI (adjusted hazard ratio: 1.660; 95% confidence interval: 1.000–2.755; p = 0.020) was higher in the diabetes group than in the prediabetes group. In all three different glycemic groups, BB + RASI users showed reduced MACEs, cardiac death, and HHF compared to those of BB + RASI nonusers. In this retrospective observational registry study, BB + RASI therapy showed comparable clinical outcomes except for Re-MI between prediabetes and diabetes in patients with AMI during a two-year follow-up period.

Comparative Effect of Statin Intensity Between Prediabetes and Type 2 Diabetes Mellitus After Implanting Newer-generation Drug-eluting Stents in Korean Acute Myocardial Infarction Patients: a Retrospective Observational Study

“…To determine meaningful variables, all variables with p < 0.001 were included in the univariate analysis (Supplementary material 2). After univariate analysis, variables with p < 0.001 and known conventional risk factors of poor outcomes in the AMI population were considered potential confounding factors, and were entered into the multivariate analysis [22]. Various clinical outcomes were estimated using the Kaplan-Meier method, and intergroup differences were compared using the log-rank test.…”

Comparative effect of statin intensity between prediabetes and type 2 diabetes mellitus after implanting newer-generation drug-eluting stents in Korean acute myocardial infarction patients: a retrospective observational study

“…To determine meaningful variables, all variables with p < 0.001 were included in the univariate analysis (Additional file 1 : 6). After univariate analysis, variables with p < 0.001 and known conventional risk factors of poor outcomes in the AMI population were considered potential confounding factors, and were entered into the multivariate analysis [ 25 ]. Various clinical outcomes were estimated using the Kaplan–Meier method, and intergroup differences were compared using the log-rank test.…”