Key result
ACEI/ARB use after AMI is linked to ~20% lower 3-year mortality versus nonusers.
Why the study?
There is no consensus whether ACEI and ARB should be used for secondary prevention in all or only high-risk patients after an acute myocardial infarction across different risk profiles.
Does ACEI/ARB treatment improve survival and reduce cardiovascular events in AMI survivors across all strata of renal function?
Cohort (n=64,362)
Yes
Does ACEI/ARB treatment improve survival and reduce cardiovascular events in AMI survivors across all strata of renal function?
Hazard Ratio: 0.8 (95% CI 0.77–0.83)
Absolute Event Rate: 17.4% vs 25.4%
ACEI/ARB therapy after myocardial infarction is associated with improved long-term survival and reduced MI risk across all strata of renal function, despite a small absolute increase in acute kidney injury.
ACEI/ARB use was associated with lower mortality; leaves open causal benefit requiring randomized confirmation.
BACKGROUND: There is no consensus whether angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) should be used for secondary prevention in all or in only high-risk patients after an acute myocardial infarction (AMI). OBJECTIVES: This study sought to investigate whether ACEI/ARB treatment after AMI is associated with better outcomes across different risk profiles, including the entire spectrum of estimated glomerular filtration rates. METHODS: This study evaluated discharge and continuous follow-up data on ACEI/ARB use among AMI survivors (2006 to 2009) included in a large Swedish registry. The association between ACEI/ARB treatment and outcomes (mortality, myocardial infarction, stroke, and acute kidney injury [AKI]) was studied using Cox proportional hazards models (intention-to-treat and as treated). RESULTS: In total, 45,697 patients (71%) were treated with ACEI/ARB. The 3-year mortality was 19.8% (17.4% of ACEI/ARB users and 25.4% of nonusers). In adjusted analysis, significantly better survival was observed for patients treated with ACEI/ARB (3-year hazard ratio: 0.80; 95% confidence interval: 0.77 to 0.83). The survival benefit was consistent through all kidney function strata, including dialysis patients. Overall, those treated with ACEI/ARB also had lower 3-year risk for myocardial infarction (hazard ratio: 0.91; 95% confidence interval: 0.87 to 0.95), whereas treatment had no significant effect on stroke risk. The crude risk for AKI was in general low (2.5% and 2.0% for treated and nontreated, respectively) and similar across estimated glomerular filtration rate categories but was significantly higher with ACEI/ARB treatment. However, the composite outcome of AKI and mortality favored ACEI/ARB treatment. CONCLUSIONS: Treatment with ACEI/ARB after AMI was associated with improved long-term survival, regardless of underlying renal function, and was accompanied by low rates of adverse renal events.
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Evans et al. (2016) conducted a cohort in Acute myocardial infarction (AMI) (n=64,362). Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARB) vs. Nonusers was evaluated on 3-year mortality (HR 0.80, 95% CI 0.77-0.83). ACEI/ARB treatment after acute myocardial infarction was associated with lower 3-year mortality compared to nonusers (17.4% vs 25.4%; HR 0.80; 95% CI 0.77-0.83).
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