Korean J Intern Med.  2016 Mar;31(2):267-276. 10.3904/kjim.2014.268.

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

Affiliations
  • 1Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. scchae@knu.ac.kr
  • 2Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
  • 3Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
  • 4Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
  • 5Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea.
  • 6Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center, Seoul, Korea.

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.

Keyword

Angiotensin-converting enzyme inhibitors; Angiotensin II type 1 receptor blockers; Myocardial infarction; Mortality; Secondary prevention

MeSH Terms

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
Angiotensin II Type 1 Receptor Blockers
Angiotensin-Converting Enzyme Inhibitors
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