Key result
In patients with acute myocardial infarction who underwent percutaneous coronary intervention, ARB use was associated with a 23% lower risk of major adverse cardiovascular events compared to ACEIs (HR 0.774).
Why the study?
The effectiveness of angiotensin II receptor blockers compared with angiotensin converting enzyme inhibitors in patients with acute myocardial infarction has not been established.
Does regular use of ARBs compared to ACEIs reduce major adverse cardiovascular events in patients with acute myocardial infarction who underwent percutaneous coronary intervention?
Cohort (n=50,864)
Yes
Does regular use of ARBs compared to ACEIs reduce major adverse cardiovascular events in patients with acute myocardial infarction who underwent percutaneous coronary intervention?
Hazard Ratio: 0.774 (95% CI 0.715–0.838)
p-value: p=<0.001
In a large Korean nationwide cohort of AMI patients undergoing PCI, regular use of ARBs was associated with a significantly lower risk of MACE, death, MI, and revascularization compared to ACEIs.
ARB preference post-AMI PCI may warrant consideration; leaves open superiority versus ACEIs in randomized trials.
BACKGROUND AND OBJECTIVES: The effectiveness of angiotensin II receptor blockers (ARBs) compared with angiotensin converting enzyme inhibitors (ACEIs) in patients with acute myocardial infarction (AMI) has not been established. We investigated the effects of ARBs on clinical outcomes after percutaneous coronary intervention (PCI) in AMI patients. METHODS: Patients receiving ACEIs or ARBs after AMI treated with PCI between January 2005 and December 2014 were selected from the Korean National Health Insurance Service database. The primary endpoint was major cardiovascular adverse event (MACE; all-cause death, myocardial infarct [MI], or stroke). RESULTS: We included patients regularly taking ACEIs (n=22,331) or ARBs (n=28,533) (medication possession ratio ≥80%). Compared with the ACEI group, the ARB group contained more females (31% vs. 18%), were older (mean, 63 vs. 60 years), and had more comorbidities, including hypertension (62.8% vs. 44.8%), diabetes (33.9% vs. 26.4%), congestive heart failure (7.9% vs. 4.3%), chronic obstructive pulmonary disease (25.5% vs. 18.9%), and end-stage renal disease (1.3% vs. 0.4%) (p<0.001 for all). After propensity score-matching, ARBs were associated with a 23% lower risk of MACE (hazard ratio [HR], 0.774; 95% confidence interval [CI], 0.715-0.838; p<0.001) than ACEIs. ARB use was also associated with a significantly reduced risk of death (HR, 0.741; 95% CI, 0.659-0.834; p<0.001), MI (HR, 0.731; 95% CI, 0.638-0.837; p<0.001), and revascularization (HR, 0.816; 95% CI, 0.773-0.861; p<0.001). CONCLUSIONS: ARB use was associated with a lower risk of MACE, MI, and revascularization than ACEIs in our retrospective analysis of AMI patients who underwent PCI.
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Kim et al. (2020) conducted a cohort in Acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) (n=50,864). Angiotensin II receptor blockers (ARBs) vs. Angiotensin converting enzyme inhibitors (ACEIs) was evaluated on Major cardiovascular adverse event (MACE; composite of all-cause death, myocardial infarct, or stroke) (HR 0.774, 95% CI 0.715-0.838, p=<0.001). In patients with acute myocardial infarction who underwent percutaneous coronary intervention, ARB use was associated with a 23% lower risk of major adverse cardiovascular events compared to ACEIs (HR 0.774).
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