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Angiotensin II type 1 receptor blockers as a first choice in patients with acute myocardial infarction

  • Lee, Jang Hoon (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Bae, Myung Hwan (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Yang, Dong Heon (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Park, Hun Sik (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Cho, Yongkeun (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Won Kee (Department of Preventive Medicine, Kyungpook National University School of Medicine) ;
  • Jeong, Myung Ho (Department of Internal Medicine, Chonnam National University Hospital) ;
  • Kim, Young Jo (Department of Internal Medicine, Yeungnam University Medical Center) ;
  • Cho, Myeong Chan (Department of Internal Medicine, Chungbuk National University School of Medicine) ;
  • Kim, Chong Jin (Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center) ;
  • Chae, Shung Chull (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Korea Acute Myocardial Infarction Registry Investigators (Korea Acute Myocardial Infarction Registry Investigators)
  • Received : 2014.09.04
  • Accepted : 2014.12.17
  • Published : 2016.03.01

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 ${\geq}40%$. 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 to 0.756; 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.

Keywords

References

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