Key result
RAS inhibition post-AMI was associated with lower 3-year all-cause mortality across all subgroups (HRs 0.65-0.82) but did not reduce the incidence of new-onset AF.
Why the study?
Does RAS inhibition reduce all-cause mortality and prevent new-onset AF in patients post-AMI with or without congestive heart failure?
Cohort (n=112,648)
Yes
Does RAS inhibition reduce all-cause mortality and prevent new-onset AF in patients post-AMI with or without congestive heart failure?
RAS inhibition post-AMI is associated with reduced all-cause mortality regardless of CHF or AF status, but it does not prevent new-onset AF.
BACKGROUND: Treatment with renin-angiotensin system (RAS) inhibitors might restrain the structural/electrical remodeling associated with atrial fibrillation (AF). Limited evidence exists regarding the potential benefits of RAS inhibition post-acute myocardial infarction (AMI) in patients with AF. This study sought to assess the association between RAS inhibition and all-cause mortality and new-onset AF in patients with/without congestive heart failure (CHF) post-AMI. METHODS AND RESULTS: Patients hospitalized for AMI between 2006 and 2012 were identified in Swedish registries. Patients were stratified in 4 subgroups; patients with CHF and AF (n=11 489); patients with CHF without AF (n=31 676); patients with AF without CHF (n=10 066); and patients without both CHF and AF (n=59 417). Patients exposed to RAS inhibition were compared to nontreated. Three-year risk of all-cause mortality and new-onset AF was assessed using adjusted Cox regression analyses. At discharge, 83 291 (73.9%) patients received RAS inhibition. RAS inhibition was associated with lower 3-year risk of all-cause mortality in CHF patients with AF, adjusted hazard ratio (HR) with 95% CI 0.75 (0.70-0.81), CHF patients without AF, HR 0.65 (0.60-0.69), AF patients without CHF, HR 0.82 (0.75-0.90), and in patients without CHF and AF, HR 0.76 (0.72-0.81), respectively. RAS inhibition was not associated with lower 3-year risk of new-onset AF in patients without AF but with/without CHF; HR 0.96 (0.84-1.10) and 1.12 (1.02-1.22), respectively. CONCLUSIONS: RAS inhibition post-AMI was associated with lower risk of all-cause mortality. In patients with/without CHF, RAS inhibition was not associated with lower incidence of new-onset AF.
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Batra et al. (2017) conducted a cohort in acute myocardial infarction (n=112,648). Renin-angiotensin system (RAS) inhibitors vs. nontreated was evaluated on 3-year risk of all-cause mortality in CHF patients with AF (HR 0.75, 95% CI 0.70-0.81). RAS inhibition post-AMI was associated with lower 3-year all-cause mortality across all subgroups (HRs 0.65-0.82) but did not reduce the incidence of new-onset AF.
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