Clinical Outcome in Post-ST Segment Elevation Myocardial Infarction Patients Receiving β-Blocker and Angiotensin-converting Enzyme Inhibitor/Angiotensin Receptor Blocker versus Receiving Either Therapy Alone: A Prospective Observational Study

Abstract

Background: Cardiovascular disease (CVD) has now become the leading cause of mortality in India. A quarter of all mortality is attributable to CVD. The study is aimed to compare the use of secondary preventive therapies after percutaneous coronary intervention (PCI) in ST segment elevation myocardial infarction (STEMI) patients. Aims: To evaluate the usage of drugs, to compare the use of Beta blockers (BB) or angiotensin-converting enzyme (ACE)/angiotensin receptor blockers (ARBs) alone versus combination of beta blockers and ACE/ARBS inhibitors following PCI, and to determine the outcome after angioplasty in STEMI patients on follow-up. Methodology: This was a prospective observational study of 9-month duration from September 2021 to April 2022 involving diagnosed STEMI patients who underwent percutaneous transluminal coronary angioplasty. The study began after the approval of the study protocol by the institutional review board. The demographic details and comorbid illness were noted. Drug use pattern and clinical outcomes were recorded at the time of discharge and followed up. Statistical analysis was done using Microsoft Excel Office 2019 and rechecked with SPSS (version 25.0). P < 0.05 was considered statistically significant. Results: A total of 94 patients of either gender were enrolled in the study (mean age: 53.46 ± 11.03 years). The most common comorbidities were hypertension with diabetes mellitus in 30 patients (41.34%). A total of 85 patients underwent PCI after coronary angiography. Patients were categorized into three groups (Group 1 = BB, Group 2 = ACE inhibitor [ACE-I]/ARB, and Group 3 = BB + ACE-I/ARB). Among 81 patients, BB (70; 15.08%) were the most commonly prescribed medication, followed by ARB (66; 14.22%) and ACE-I (4; 0.86%), respectively. Ejection fraction (EF) was increased from 40.16 ± 12.112 (at baseline) to 50.94 ± 11.085 (at 4th month) in Group 3. EF was statistically improved in patients who were in Group 3 (P < 0.05). Conclusion: Our conclusions support the current American College of Cardiology/American Heart Association guidelines recommending beta-blocker therapy along with ACE-I/ARB for secondary prevention. Therefore, in this study, we suggest that the combination of BB with ACE-I/ARB may improve clinical outcomes. It also shows that patients receiving only one group were at a loss. The search for alternative drugs in such patients should be an area of extensive scientific investigation.