Why the study?
This study aimed to evaluate the long-term clinical outcomes of patients with acute myocardial infarction who underwent successful stent implantation and were treated with ACEI or ARB.
Does ACEI use at discharge reduce the composite of cardiac death and recurrent MI in older patients (≥70 years) with AMI after successful stent implantation compared to ARB?
Does ACEI use at discharge reduce the composite of cardiac death and recurrent MI in older patients (≥70 years) with AMI after successful stent implantation compared to ARB?
In older patients with AMI undergoing successful stenting, ACEI prescription at discharge is associated with lower rates of cardiac death and recurrent MI compared to ARB.
ACEI at discharge was associated with lower cardiac death than ARB in older post-stent AMI patients; leaves open whether RCTs will confirm or extend this association.
BACKGROUND: This study aimed to evaluate the long-term clinical outcomes of patients with acute myocardial infarction (AMI) who underwent successful stent implantation and were subsequently treated with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). METHODS: Among 13,104 patients enrolled in the Korean AMI registry, 2,763 older patients aged 70 years or older, who were prescribed either ACEI or ARB at discharge, were included in this study. Propensity score matching (PSM) was performed to adjust for baseline confounders. The primary outcome was a composite of cardiac death and recurrent myocardial infarction (MI) at the 3-year follow-up. RESULTS: In PSM cohort, use of ACEI at discharge was associated with a significantly lower incidence of primary outcome (hazard ratio, 1.60; 95% confidence interval, 1.20-2.14; p=0.001) compared to those of ARB at discharge. Additionally, incidences of cardiac death, recurrent MI and all-cause death were lower in use of ACEI at discharge than in those of ARB. However, there were no statistically significant differences between the two groups in hospitalization for heart failure, any revascularization, stent thrombosis, or stroke. CONCLUSION: The findings of this study suggest that ACEI use at discharge, compared with ARB use, was associated with lower incidences of cardiac death, and recurrent MI in older patients with AMI after successful stent implantation.
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Ko et al. (2025) studied this question.
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