Impacts of renin–angiotensin system inhibitors on two-year clinical outcomes in diabetic and dyslipidemic acute myocardial infarction patients after a successful percutaneous coronary intervention using newer-generation drug-eluting stents

Abstract

This study investigated the impacts of renin–angiotensin system inhibitors (RASIs) on 2-year clinical outcomes in diabetes and dyslipidemic acute myocardial infarction (AMI) patients after a successful percutaneous coronary intervention (PCI) using newer-generation drug-eluting stents (DESs). A total of 16,997 AMI patients were enrolled, and divided into four groups based on the presence or absence of diabetes and dyslipidemia as follows: diabetes –/dyslipidemia –(group A, 11,132 patients), diabetes +/dyslipidemia – (group B, 3,860 patients), diabetes –/dyslipidemia + (group C, 1,328 patients), and diabetes +/dyslipidemia + (group D, 677 patients). The clinical endpoint was the occurrence of major adverse cardiac events (MACEs), the composite of total death, recurrent myocardial infarction (re-MI), and any repeat revascularization, including target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (non-TVR). After RASIs therapy, the cumulative incidences of MACEs (adjusted hazard ratio [aHR], 1.330; 95% confidence interval [CI], 1.022–1.732; P = .034), any repeat revascularization (aHR, 1.584; 95% CI, 1.092–2.298; P = .015), TLR, and TVR were significantly higher in group B than group C. However, the cumulative incidences of all-cause death, cardiac death, re-MI, and non-TVR were similar in groups B and C. In this study, under the newer-generation DESs era, repeat revascularization rate reduction benefit of RASIs therapy in diabetic AMI patients was lesser than that in dyslipidemic AMI patients. However, larger randomized controlled studies are needed to confirm these results in the future.

Effects of lipids on inflammation and DNA damage in diabetes mellitus patients

“…However, triglyceride was higher in the dyslipidemic diabetes group. In the same study, the total cholesterol level was higher in the control group, and the fasting glucose level was higher in the diabetes-positive dyslipidemianegative group [19]. The prominent features of diabetic dyslipidemia include high triglyceride, low HDL, and increased LDL cholesterol concentrations.…”

“…Lipids are highly active in the activation of inflammatory pathways. Dyslipidemia is an important determinant of the development of atherosclerosis, which is very important for endothelial damage [19,26].…”

Application of tirofiban in patients with acute myocardial infarction complicated with diabetes and undergoing emergency interventional therapy

“… 3 Emergency percutaneous coronary intervention (PCI) has been applied as the principal method for the treatment of AMI, but it is often accompanied by myocardial hypoperfusion triggered by postoperative slow bleeding and no reflow. 4 Emergency PCI, as a proven therapy in various clinical trials, is characterized by multiple effects such as effective unblocking infarction of the associated vessels, recovery of myocardial reperfusion, effective rescue of ischemic myocardium, and improvement of long-term prognosis. A majority of patients with diabetes complicated with myocardial infarction have severe coronary artery lesions, no intraoperative reflow, insufficient myocardial perfusion, and increased probability of stent thrombosis postoperatively, which greatly affects the prognosis of patients.…”