Effect of Angiotensin Receptor Blocker Dose in Myocardial Infarction With Preserved Left Ventricular Systolic Function.

ABSTRACT: There have been few studies of angiotensin receptor blocker (ARB) dose in myocardial infarction (MI) with preserved left ventricular (LV) systolic function. We evaluated the association of ARB dose with clinical outcomes after MI with preserved LV systolic function. We used MI multicenter registry. Six months after discharge, the ARB dose was indexed to the target ARB doses used in randomized clinical trials and grouped as >0%-25% (n = 2333), >25% of the target dose (n = 1204), and no ARB (n = 1263). The primary outcome was the composite of cardiac death or MI. Univariate analysis showed that mortality of those with any ARB dose was lower than those without ARB therapy. After multivariable adjustment, patients receiving >25% of target dose had a similar risk of cardiac death or MI compared with those receiving ≤25% or no ARB [hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.83-1.33; HR 0.94, 95% CI 0.82-1.08, respectively]. Propensity score analysis also demonstrated that patients with >25% dose had no difference in primary endpoint compared with those ≤25% dose or the no ARB group (HR 1.03, 95% CI 0.79-1.33; HR 0.86, 95% CI 0.64-1.14, respectively). The present study demonstrates that patients treated with >25% of target ARB dose do not have better clinical outcomes than those treated with ≤25% of target ARB dose or those with no ARB dose in MI patients with preserved LV systolic function.

Incidence and clinical impact of fracture of drug-eluting stents widely used in current clinical practice: comparison with initial platform of sirolimus-eluting stent.

BACKGROUND: Almost all data on drug-eluting stents (DES) fracture have been derived from initial platform of first-generation DES such as Cypher Bx® (CBX) and Taxus Express®. However, incidence and clinical impact of fracture of newer DES platforms (including Cypher Select®, Taxus® Liberté™, Endeavor®, and Xience™ V) that have been used widely in current clinical practice have not yet been studied. METHODS AND RESULTS: We analyzed data of 1518 lesions treated with the newer DES platforms in patients who underwent follow-up coronary angiography and compared the results with those of 622 lesions treated with the CBX. The group of newer DES platforms showed significantly lower incidence of stent fracture (SF) than the CBX group (1.25% vs. 5.8%, p<0.001). Binary restenosis (42.1% vs. 6.6%, p<0.001) and target lesion revascularization (TLR) (47.3% vs. 6.2%, p<0.001) related to SF in the newer DES platforms' group were significantly higher than those not related to SF. Notably, SF-related binary restenosis (42.1% vs. 36.1%, p=0.52) and TLR (47.3% vs. 41.6%, p=0.2) were similar between the newer DES platforms' group and the CBX group. On multivariable logistic regression analysis, lesion angulation>45° (odds ratio [OR]: 7.6; 95% confidence interval [CI]: 2.2-26.31), RCA stenting (OR: 5.14; 95% CI: 1.62-16.3) and total stent length (OR: 1.18; 95% CI: 1.03-1.33) were identified as independent predictors for fracture of the newer DES platforms, while closed-cell design stent (Cypher Select®) was not. CONCLUSIONS: Although implantation of the newer DES platforms might reduce the occurrence of SF compared with the CBX, SF-related binary restenosis and TLR remain similarly high. And to predict SF in the newer DES platforms' era, lesion characteristics on index procedure are more important than implanted stent design.