Percutaneous coronary intervention (PCI) is the mainstay treatment of acute myocardial infarction (AMI); however, many clinicians are reluctant to perform PCI in the elderly population. This study aimed to compare the clinical outcomes of PCI versus medical therapy in nonagenarian Korean patients with AMI. We compared the clinical outcomes of nonagenarian patients with AMI with or without PCI. From the pooled data, based on a series of Korean AMI registries during 2005–2020, 467 consecutive patients were selected and categorized into two groups: the PCI and no-PCI groups. The primary endpoint was 1-year major adverse cardiac event (MACE), a composite of all-cause death, non-fatal myocardial infarction, and any revascularization. Among the 467 participants, 68.5% received PCI. The PCI group had lower proportions of Killip classes III-IV, previous heart failure, and left ventricular ejection fraction <40%, but had higher proportions of all prescribed medications and STEMI diagnosis. The 1-year MACE and all-cause death were higher in the no-PCI group, although partially attenuated post-IPTW. Our study showed that nonagenarian patients with AMI undergoing PCI had better clinical outcomes than those without PCI. Nonetheless, further investigation is needed in the future to elucidate whether PCI is beneficial for this population.

Oh S, et al. Korean Circ J. 2024 Jun;54:e73. https://doi.org/10.4070/kcj.2024.0085

Oh S, et al. Korean Circ J. 2025 Jan;55(1):50-64. https://doi.org/10.4070/kcj.2024.0171

Background: Dyslipidemia is an important risk factor for acute myocardial infarction. However, real-world data on its prevalence and lipid management trends for Korean patients with acute myocardial infarction are limited. This study aimed to determine the 10-year temporal trends in dyslipidemia prevalence and lipid management in this patient population. Methods and findings: The study used a merged database of two nationwide observational cohorts (2011–2020) that included 26,751 participants. The primary endpoints were the achievement rates of the (1) absolute low-density lipoprotein cholesterol (LDL-C) target of <70 mg/dL (50% from the baseline, (3) absolute or relative LDL-C target (American target), and (4) both absolute and relative LDL-C targets (European target). The dyslipidemia prevalence increased from 11.1% to 17.1%, whereas the statin prescription rate increased from 92.9% to 97.0% from 2011 to 2020. The rate of high-intensity statin use increased from 12.80% in 2012 to 69.30% in 2020. The rate of ezetimibe use increased from 4.50% in 2016 to 22.50% in 2020. The high-intensity statin and ezetimibe prescription rates (0.20% to 9.30% from 2016 to 2020) increased gradually. The absolute and relative LDL-C target achievement rates increased from 41.4% and 20.8% in 2012 to 62.5% and 39.5% in 2019, respectively. The American (45.7% in 2012 to 68.6% in 2019) and European (16.5% in 2012 to 33.8% in 2019) target achievement rates also increased. Conclusions: The adoption of lipid management guidelines in clinical practice has improved. However, continued efforts are needed to reduce the risk of recurrent ischemic events.

Purpose While clinical benefits of beta-blockers are well-established in patients with acute myocardial infarction and reduced left ventricular ejection fraction (< 40%) (AMI-rEF), but their efficacy in patients with low heart rates (H-Rs) remains unclear. This study aimed to evaluate the association between beta-blockers and 3-year mortality outcomes according to H-R in this population. Methods We analyzed 2,941 patients with AMI-rEF from two nationwide Korean registries, stratified by discharge H-R (< 75 or ≥ 75 beats per minute). The primary outcome was 3-year all-cause death. Propensity score matching and multivariable Cox models adjusted for baseline differences. Results On unadjusted analysis, beta-blocker use was associated with lower all-cause death (16.1% vs. 23.3%; hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.52–0.76) and cardiac death (9.8% vs. 15.2%; HR, 0.59; 95% CI, 0.47–0.75). However, after adjustment, these associations were attenuated. Beta-blockers were associated with a significantly increased risk of nonfatal myocardial infarction (HR, 2.29; 95% CI, 1.14–4.59), particularly in patients with discharge H-R ≥ 75 bpm (HR, 3.34; 95% CI, 1.13–9.92). Conclusion In patients with AMI-rEF, beta-blockers were not independently associated with significantly reduced all-cause death after adjustment, though a trend was observed. Notably, beta-blocker use increased the risk of nonfatal myocardial infarction, particularly at higher H-R. These findings suggest that the benefits of beta-blockers in this population may not be uniform and highlight the potential importance of H-R as a clinical marker to guide individualized beta-blocker use in the contemporary post-AMI setting.

To compare the clinical outcomes of patients with acute myocardial infarction with renal impairment (AMI-RI) treated with either angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in real-world clinical settings. A total of 4790 consecutive patients with AMI-RI between November 1, 2011, and December 31, 2015, were subdivided into ACEI (n=2845) and ARB (n=1945) treatment groups. The primary end points were major adverse cardiac and cerebrovascular events, including all-cause mortality, nonfatal myocardial infarction, any revascularization, cerebrovascular accident, rehospitalization, and stent thrombosis. Propensity score matching (PSM) was used to adjust for group differences. The ARB group had a significantly higher incidence of major adverse cardiac and cerebrovascular events (at 3-year follow-up) than the ACEI group according to the unadjusted analysis (3-year hazard ratio [HR], 1.60; 95% CI, 1.43 to 1.78) and the PSM-adjusted analysis (3-year HR, 1.34; 95% CI, 1.15 to 1.56). However, any revascularization (3-year HR, 1.21; 95% CI, 0.95 to 1.54) and rehospitalization (3-year HR, 1.21; 95% CI, 0.88 to 1.67) were not significantly different between groups in the PSM-adjusted analysis. Compared with the ARB group, the ACEI group had lower rates of all-cause mortality at estimated glomerular filtration rates of at least 15 or less than 90 mL/min/1.73 m² in the unadjusted data and at least 60 or less than 90 mL/min/1.73 m² in the PSM-adjusted analysis. Treatment with ACEIs seemed to be more beneficial than treatment with ARBs for patients with AMI-RI; further prospective studies are required to confirm these results.