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| The Long-term Clinical Outcomes of Combination Therapy with Angiotensin II Type 1 Receptor Blocker and Simvastatin After Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction |
| The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Science, Gwangju, Korea |
| Young Joon Hong, Young Keun Ahn, Sang Yup Lim, Sang Hyun Lee, Seo Na Hong, Kyung Ho Yun, Kye Hun Kim, Dong Goo Kang, Yeon Sang Lee, Ju Han Kim, Weon Kim, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, and Jung Chaee Kang |
Background and Objectives : It has been known that angiotensin II type 1 receptor blocker (ARB) attenuated neointimal formation and vascular smooth muscle cell proliferation, with a decrease in inflammation. Recent studies have demonstrated that statins may contribute to the beneficial effects of ARB on vascular diseases. The aim of this study was to evaluate the beneficial effects of combination therapy of ARB and statins compared to combination therapy of angiotensin converting enzyme inhibitor (ACEI) and statins in acute myocardial infarction (AMI) patients who underwent percutaneous coronary intervention (PCI). Subjects and Methods : A total of 396 patients with AMI who underwent PCI between June 2001 and June 2003 at Chonnam National University Hospital were divided into two groups: Group I (n=188, 62.9±11.4 years, male 66.3%) who were treated with ARB and simvastatin and Group II (n=208, 59.4±12.1 years, male 72.3%) who were treated with ACEI and simvastatin after PCI. Results : There were no significant differences in major adverse cardiac events during hospital admission. Six-month follow-up angiogram was performed in 65% in Group I and 67% in Group II. The incidence of repeat PCI rate was not different significantly between two groups (Group I: 24/122, 19.7% vs. Group II: 30/140, 21.4%, p=0.726). There were no significant differences in the incidence of nonfatal myocardial infarction, bypass graft and death at one-year clinical follow-up between two groups. The event-free survival rate was 78.7% in Group I (148/188) and 76.0% in Group II (158/208) (p=0.513). Subgroup analysis was performed for the patients with elevated C-reactive protein levels (CRP>0.5 mg/dL). In this subgroup anlaysis, the incidence of repeat PCI rate was not different significantly between two groups (24% vs. 26%, p=0.695) and the event-free survival rate was 70.7% in Group I and 68.8% in Group II (p=0.730). Conclusions : The combination therapy of ARB with statins may not show more beneficial effects compared to ACEI with statins in AMI patients who underwent PCI even in the patients with elevated CRP levels.
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