Timing of RAS blocker administration and long-term cardiovascular outcomes in STEMI patients.

Abstract

Background: Renin-angiotensin system (RAS) blockers constitute a cornerstone in the management of patients with cardiovascular disease. However, the relationship between the administration time of these drugs during the day and cardiovascular events is not yet fully elucidated. We aimed to examine the relationship between the administration time of RAS blockers during the day and long-term cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI).

Methods: A total of 701 patients who were admitted to our hospital between 2018 and 2020 with STEMI and underwent primary percutaneous coronary intervention (PCI) were included in this single-center, retrospective, observational study. Primary endpoints were acute heart failure (AHF), nonfatal myocardial infarction, major adverse cardiovascular events (MACE), and long-term mortality. Patients were divided into two group according to the administration of RAS blockers in the morning (06:00-10:00) or evening (20:00-00:00).

Results: The mean age of the patients was 57.5 ± 11.9 years and 75.9% were male. After discharge, 485 patients were taking RAS blockers in the morning and 216 patients were taking them in the evening. There was a significantly higher rate of AHF, nonfatal myocardial infarction, MACE, and death in the group taking RAS blockers in the morning compared to the group taking them in the evening (p < 0.01, p = 0.02, p < 0.01, p < 0.01, respectively).

Conclusion: Routine administration of RAS blockers in the evening rather than in the morning led to a remarkable decrease in the occurrence of AHF, nonfatal myocardial infarction, MACE, and mortality.