Key result
In patients with acute myocardial infarction without hypertension, the use of ACEI significantly reduced the 3-year incidence of major adverse cardiac events (HR 0.843) compared to ARB.
Why the study?
To investigate the impact of ACEI versus ARB on 3-year clinical outcomes in AMI patients without hypertension undergoing successful PCI with DES.
Does ACEI reduce 3-year MACE compared to ARB in AMI patients without hypertension who underwent successful PCI with DES?
Cohort (n=3,993)
Yes
Does ACEI reduce 3-year MACE compared to ARB in AMI patients without hypertension who underwent successful PCI with DES?
Hazard Ratio: 0.843 (95% CI 0.74–0.96)
Absolute Event Rate: 12% vs 13.9%
p-value: p=0.010
In AMI patients without hypertension undergoing PCI, ACEI therapy is associated with better 3-year clinical outcomes, including reduced MACE and HF hospitalization, compared to ARB therapy.
ACEI may be preferable to ARB in normotensive post-PCI AMI; leaves open need for randomized confirmation.
This study aimed to investigate the impact of angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II type 1 receptor blockers (ARB) on 3-year clinical outcomes in acute myocardial infarction (AMI) patients without a history of hypertension who underwent successful percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 13,104 AMI patients who were registered in the Korea AMI registry (KAMIR)-National Institutes of Health (NIH) were included in the study. The primary endpoint was 3-year major adverse cardiac events (MACE), which was defined as the composite of all-cause death, recurrent myocardial infarction (MI), and any repeat revascularization. To adjust baseline potential confounders, an inverse probability weighting (IPTW) analysis was performed. The patients were divided into two groups: the ACEI group, n = 4,053 patients and the ARB group, n = 4,107 patients. During the 3-year clinical follow-up, the cumulative incidences of MACE (hazard ratio [HR], 0.843; 95% confidence interval [CI], 0.740-0.960; p = 0.010), any repeat revascularization (HR, 0.856; 95% CI, 0.736-0.995; p = 0.044), stroke (HR, 0.613; 95% CI, 0.417-0.901; p = 0.013), and re-hospitalization due to heart failure (HF) (HR, 0.399; 95% CI, 0.294-0.541; p <0.001) in the ACEI group were significantly lower than in the ARB group. In Korean patients with AMI without a history of hypertension, the use of ACEI was significantly associated with reduced incidences of MACE, any repeat revascularization, stroke, and re-hospitalization due to HF than those with the use of ARB.
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Her et al. (2020) conducted a cohort in Acute myocardial infarction without hypertension (n=3,993). Angiotensin-converting-enzyme inhibitors (ACEI) vs. Angiotensin II type 1 receptor blockers (ARB) was evaluated on 3-year major adverse cardiac events (MACE), defined as the composite of all-cause death, recurrent myocardial infarction (MI), and any repeat revascularization (HR 0.843, 95% CI 0.740-0.960, p=0.010). In patients with acute myocardial infarction without hypertension, the use of ACEI significantly reduced the 3-year incidence of major adverse cardiac events (HR 0.843) compared to ARB.
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