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We evaluated whether prior statin therapy reduces in-hospital ventricular tachycardia/ventricular fibrillation (VT/VF) in percutaneous coronary intervention (PCI) patients with acute myocardial infarction (MI). Among the 1177 patients from the Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH), 823 (70%) patients received prior statin therapy. Prior statin therapy was associated with a reduced risk of VT/VF events in both adjusted propensity score analysis (odds ratio [OR] 0.414, 95% confidence interval [CI], 0.198-0.865, P = .019) and adjusted inverse probability of treatment weight analysis (OR 0.463, 95% CI, 0.216-0.994, P = .048). The risk of in-hospital death did not differ significantly between those with or without prior statin therapy (hazard ratio [HR] 0.416, 95% CI, 0.112-1.548, P = .191). Major adverse cardiac events occurred in 116 (8.9%) patients during follow-up. Prior statin therapy was associated with a lower risk of major adverse cardiac events during the follow-up period (HR 0.486, 95% CI, 0.243-0.974, P = .042); however, this was mainly driven by reduced noncardiac death. Prior statin therapy might reduce the incidence of serious cardiac tachyarrhythmia, such as VT/VF, in patients with MI undergoing PCI. However, the reduction in VT/VF due to prior statin therapy did not improve short- and long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

We compared outcomes between biodegradable polymer biolimus-eluting stent (BP-BES) and new-generation durable polymer drug-eluting stent (DP-DES) implantations in patients with acute myocardial infarction (MI). Among 13472 patients with acute MI in a nationwide registry, 557 (64.8%) were in the BP-BES and 303 (35.2%) in the new-generation DP-DES group following coronary reperfusion. The occurrence of major adverse cardiac events (MACE; death, MI, revascularization) and stent thrombosis was compared. Major adverse cardiac events occurred in 53 (6.2%) patients and showed similar rates between the BP-BES and new-generation DP-DES groups (all: 6.6% vs 5.9%, P = .652; propensity score [PS] matched: n = 380, 6.3% vs 5.3%, P = .623). Stent thrombosis did not differ between groups (all: 0.3% vs 0.4%, P = .892; PS matched: 0.5% vs 0.5%, P = 1.000). Major adverse cardiac event-free survival was comparable between groups (all: 93.4% vs 94.1%, log-rank P = .357; PS matched: 93.7% vs 94.7%, log-rank P = .445). Biodegradable polymer biolimus-eluting stent was not associated with MACE (all: hazard ratio [HR], 1.67; 95% confidence interval [CI], 0.75-3.74; P = 0.212; PS matched: HR, 1.05; 95% CI, 0.40-2.75; P = .915). In conclusion, in patients with acute MI, BP-BES was equivalent to the new-generation DP-DES in terms of outcomes. [ABSTRACT FROM AUTHOR]

We determined the incidence, predictors, and outcomes of persistent renal dysfunction (PRD) following percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Among 16 264 patients enrolled in a nationwide registry, we studied patients with AMI who had their estimated glomerular filtration rate at baseline and 1 month later (n = 3606). We used multivariate regression and propensity score (PS)-matched Cox proportional hazards to evaluate the association between PRD and outcomes. Persistent renal dysfunction occurred in 1333 (37%) patients. Significant PRD contributors included old age, low body mass index (BMI), hypertension, Killip class, and the extent of vessel disease. Persistent renal dysfunction was associated with an increased 1-year major adverse cardiac events (all-cause death, myocardial infarction, or revascularization) relative to no-PRD (entire cohort: 6.2% vs 4.5%, hazard ratio[HR] 1.63, 95% confidence interval [CI] 1.18-2.25, P = .003; PS-matched cohort: 7.2% vs 4.9%, HR 1.67, 95% CI 1.08-2.58, P = .022). In conclusion, PRD occurred in approximately one-third of patients with AMI following PCI. It was associated with old age, hypertension, low BMI, initial hemodynamic instability, and extent of vessel disease and was a predictor of worse outcomes at 1 year. [ABSTRACT FROM AUTHOR]

Background It is unclear whether simvastatin–ezetimibe could be an alternative therapy to high-intensity statin therapy in high-risk patients. The aim of this study was to compare the clinical outcomes of simvastatin–ezetimibe and high-intensity statin therapy in patients with acute myocardial infarction (AMI), and especially in those with high-risk factor. Methods A total of 3520 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were classified into simvastatin–ezetimibe group (n = 1249) and high-intensity statin group (n = 2271). Multivariate analysis and propensity-score matching analysis were performed. The primary endpoint was major adverse cardiac events (MACE) at 12-months follow-up. Results In overall AMI patients, MACE occurred in 116 patients (9.3%) in simvastatin–ezetimibe group and 116 patients (5.1%) in high-intensity statin group. The difference in MACE between groups was driven by repeat revascularization (5.9% vs. 2.2%). After propensity matching analysis, simvastatin–ezetimibe was associated with a higher incidence of MACE than high-intensity statin therapy (adjusted hazard ratio: 3.090, 95% confidence interval: 1.715 to 5.566, p < 0.001). However, in patients with high-risk factors, such as diabetes, old age, or heart failure, simvastatin-ezetimibe had similar incidence of MACE compared with high-intensity statin therapy in further adjusted analysis. Conclusions In overall AMI patients, high-intensity statin therapy had better clinical outcomes than simvastatin–ezetimibe. However, in patients with high-risk factor, simvastatin–ezetimibe had comparable clinical outcomes to high-intensity statin therapy. Therefore, simvastatin–ezetimibe could be used as an alternative to high-intensity statin therapy in such patients. [ABSTRACT FROM AUTHOR]

Background Immediate invasive approach for non-ST-segment elevation myocardial infarction (NSTEMI) may permit treatment of the underlying plaque rupture as early as possible with subsequent reduction of death and myocardial infarction (MI). We sought to assess clinical impact of immediate percutaneous coronary intervention (PCI) for NSTEMI. Methods A total of 6134 NSTEMI patients undergoing PCI from the Korea Acute Myocardial Infarction Registry were divided into group 1 (immediate PCI within 4 h, n = 1132) and group 2 (non-immediate PCI after 4 h, n = 5002). Propensity-matched 12-month clinical outcome was compared. Results In all patients and propensity-matched cohort (n = 1131 in each group), group 1 had higher peak troponin level, higher rate of pre-PCI Thrombolysis In Myocardial Infarction (TIMI) grade 0 or 1, higher use of glycoprotein IIb/IIIa inhibitor, and lower use of unfractionated heparin and nitrates. In all patients, 12-month rates of MI and death/MI were higher in group 1. No differences were observed in 12-month death and major adverse cardiac events (MACE: composite of death, MI, target-vessel revascularization, and coronary artery bypass graft surgery). In propensity-matched cohort, no significant differences were observed in 12-month rates of death, MI, death/MI or MACE. However, group 1 had less major bleeding (0.8% vs. 3.0%, p = 0.024) and shorter hospital stay. Conclusions Immediate PCI for patients with NSTEMI was associated with lower pre-PCI culprit vessel patency and not with improved 12-month clinical outcome. [ABSTRACT FROM AUTHOR]

Abstract: Background: The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). Methods: We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. Results: In the overall population, the MACEs rate in 1year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p=0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p=0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p=0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. Conclusions: In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI. [Copyright &y& Elsevier]

The optimal loading dose of clopidogrel in patients with chronic kidney disease who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction has not been investigated. The aim of this study was to assess the impact of clopidogrel loading dose on clinical outcomes in this setting. A total of 1,457 patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2) were evaluated according to clopidogrel loading dose: 600 mg (n = 861) versus 300 mg (n = 596). In-hospital complications, including major bleeding and clinical outcomes at 1 and 12 months, were compared between the 2 groups. The in-hospital major bleeding rate was similar (0.8% vs 0.2%, p = 0.09). Also, there were no differences in major adverse cardiac event rates, including death, recurrent myocardial infarction, target lesion revascularization, and stent thrombosis, at 1 month (15.6% vs 16.4%, p = 0.70) and 12 months (19.0% vs 21.3%, p = 0.32). On multivariate analysis, a 600-mg loading dose of clopidogrel was not an independent predictor of 1-month (odds ratio 1.13, 95% confidence interval 0.49 to 2.57, p = 0.78) and 12-month (odds ratio 0.89, 95% confidence interval 0.52 to 1.51, p = 0.66) major adverse cardiac events. After propensity score–matched analysis, these results were unchanged. In conclusion, a 600-mg loading dose of clopidogrel was not effective in reducing 1- and 12-month major adverse cardiac events in patients with chronic kidney disease who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, but this dose did not increase the in-hospital major bleeding rate. [Copyright &y& Elsevier]

The clinical benefit of percutaneous coronary intervention (PCI) is controversial in stable early latecomers with ST-segment elevation myocardial infarction (STEMI). We evaluated the efficacy of PCI in 2,344 stable patients with STEMI presenting 12 to 72 hours after symptom onset. Patients who had impaired hemodynamics or who had undergone fibrinolysis or immediate or urgent PCI were excluded. The patients were divided into the PCI group (n = 1,889) and medical treatment group (n = 455). The 12-month clinical outcome was compared between the 2 groups. After adjustment using propensity score stratification, the PCI group had lower mortality (3.1% vs 10.1%; hazard ratio 0.31; 95% confidence interval 0.20 to 0.47; p <0.001) and a lower incidence of composite death/myocardial infarction (3.8% vs 11.2%; hazard ratio 0.36; 95% confidence interval 0.25 to 0.53; p <0.001) at 12 months. The benefit of PCI was consistent across all subgroups, including patients presenting without chest pain. In conclusion, in stable patients with STEMI presenting 12 to 72 hours after symptom onset, PCI was associated with significant improvement in the 12-month clinical outcome. [ABSTRACT FROM AUTHOR]

Objectives: We investigated whether statin therapy could be beneficial in patients with acute myocardial infarction (AMI) who have baseline low-density lipoprotein cholesterol (LDL-C) levels below 70 mg/dl. Background: Intensive lipid-lowering therapy with a target LDL-C value <70 mg/dl is recommended in patients with very high cardiovascular risk. However, whether to use statin therapy in patients with baseline LDL-C levels below 70 mg/dl is controversial. Methods: We analyzed 1,054 patients with AMI who had baseline LDL-C levels below 70 mg/dl and survived at discharge from the Korean Acute MI Registry between November 2005 and December 2007. They were divided into 2 groups according to the prescribing of statins at discharge (statin group n = 607; nonstatin group n = 447). The primary endpoint was the composite of 1-year major adverse cardiac events, including death, recurrent MI, target vessel revascularization, and coronary artery bypass grafting. Results: Statin therapy significantly reduced the risk of the composite primary endpoint (adjusted hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.34 to 0.89; p = 0.015). Statin therapy reduced the risk of cardiac death (HR: 0.47; 95% CI: 0.23 to 0.93; p = 0.031) and coronary revascularization (HR: 0.45, 95% CI: 0.24 to 0.85; p = 0.013). However, there were no differences in the risk of the composite of all-cause death, recurrent MI, and repeated percutaneous coronary intervention rate. Conclusions: Statin therapy in patients with AMI with LDL-C levels below 70 mg/dl was associated with improved clinical outcome. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare clinical outcomes among early invasive (EI), deferred invasive (DI), and conservative strategies in patients with acute non–ST-segment elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). High-risk patients with NSTEMI are believed to fare better with an EI strategy, but the optimal treatment for patients with NSTEMI and CKD is not known. In total 5,185 patients with acute NSTEMI were enrolled from the Korea Acute Myocardial Infarction Registry and followed for 1 year. Patients were divided into EI, DI, and conservative treatment groups and classified into 4 stages using references from the National Kidney Foundation. The invasive EI and DI groups were compared to the conservative groups, and the EI and DI groups were compared according to each renal function stage. At 1-year follow-up, mortality rates in the conservative group were significantly higher than in the invasive groups except for the severe CKD group. The benefit of the EI over the DI strategy, although there were no significant differences between the 2 groups, tended to decrease as renal function decreased. In conclusion, in the management of NSTEMI, an invasive strategy decreased mortality compared to a conservative strategy except for severe CKD. In the timing of an invasive strategy, the EI strategy was observed to be superior to the DI strategy in patients with mild CKD; however, this tendency reversed as renal function decreased. When patients with NSTEMI have severe CKD, a conservative or DI strategy with prescription of cardioprotective medications and prevention of further deterioration in renal function should be considered. [ABSTRACT FROM AUTHOR]