Angiotensin II type 1 receptor blockers as a first choice in patients with acute myocardial infarction.
- Author:
Jang Hoon LEE
1
;
Myung Hwan BAE
;
Dong Heon YANG
;
Hun Sik PARK
;
Yongkeun CHO
;
Won Kee LEE
;
Myung Ho JEONG
;
Young Jo KIM
;
Myeong Chan CHO
;
Chong Jin KIM
;
Shung Chull CHAE
Author Information
- Publication Type:Comparative Study ; Multicenter Study ; Observational Study ; Original Article
- Keywords: Angiotensin-converting enzyme inhibitors; Angiotensin II type 1 receptor blockers; Myocardial infarction; Mortality; Secondary prevention
- MeSH: Angiotensin II Type 1 Receptor Blockers/adverse effects/*therapeutic use; Angiotensin-Converting Enzyme Inhibitors/adverse effects/*therapeutic use; Chi-Square Distribution; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Multivariate Analysis; Myocardial Infarction/diagnosis/*drug therapy/mortality/physiopathology; Proportional Hazards Models; Prospective Studies; Recurrence; Registries; Republic of Korea; Risk Factors; Secondary Prevention/*methods; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left
- From:The Korean Journal of Internal Medicine 2016;31(2):267-276
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Angiotensin II type 1 receptor blockers (ARBs) have not been adequately evaluated in patients without left ventricular (LV) dysfunction or heart failure after acute myocardial infarction (AMI). METHODS: Between November 2005 and January 2008, 6,781 patients who were not receiving angiotensin-converting enzyme inhibitors (ACEIs) or ARBs were selected from the Korean AMI Registry. The primary endpoints were 12-month major adverse cardiac events (MACEs) including death and recurrent AMI. RESULTS: Seventy percent of the patients were Killip class 1 and had a LV ejection fraction > or = 40%. The prescription rate of ARBs was 12.2%. For each patient, a propensity score, indicating the likelihood of using ARBs during hospitalization or at discharge, was calculated using a non-parsimonious multivariable logistic regression model, and was used to match the patients 1:4, yielding 715 ARB users versus 2,860 ACEI users. The effect of ARBs on in-hospital mortality and 12-month MACE occurrence was assessed using matched logistic and Cox regression models. Compared with ACEIs, ARBs significantly reduced in-hospital mortality(1.3% vs. 3.3%; hazard ratio [HR], 0.379; 95% confidence interval [CI], 0.190 to0.756; p = 0.006) and 12-month MACE occurrence (4.6% vs. 6.9%; HR, 0.661; 95% CI, 0.457 to 0.956; p = 0.028). However, the benefit of ARBs on 12-month mortality compared with ACEIs was marginal (4.3% vs. 6.2%; HR, 0.684; 95% CI, 0.467 to 1.002; p = 0.051). CONCLUSIONS: Our results suggest that ARBs are not inferior to, and may actually be better than ACEIs in Korean patients with AMI.
