Losartan Versus Ramipril on 3-year Clinical Outcomes After Acute Myocardial Infarction in Korean Population: From the Korea Acute Myocardial Infarction Registry-National Institutes of Health

Background: This study was to investigate the clinical impact of Losartan as an angiotensin II receptor blocker (ARB) and Ramipril as angiotensin-converting enzyme inhibitors (ACEIs) on 3-year clinical outcomes in acute myocardial infarction (AMI) patients who underwent successful percutaneous coronary intervention (PCI) with drug-eluting stent (DES).Methods: A Total of 13,104 AMI patients were enrolled in Korea Acute Myocardial Infarction Registry-National Institutes of Health from November 2011 to December 2015.The key combined primary endpoint was major adverse cardiac events (MACE), the composite of total death, MI, and revascularization.The key secondary endpoints were the occurrence of any clinical events such as total death, myocardial infarction (MI), revascularization, stroke, and re-hospitalization due to heart failure.To adjust baseline potential confounders, a propensity score matching (PSM) analysis was performed and the key endpoints up to 3-year were evaluated.Results: After PSM analysis, 2 matched groups (534 pairs) were generated and their baseline patient-and procedure-related characteristics were well balanced.During 3-year clinical follow up, there were no differences in the incidence of key combined primary and secondary endpoints between the 2 groups.However, there was a trend toward lower incidence of revascularization in the Losartan group (40 [7.5%] vs. 58 [10.9%],P = 0.06) and ischemic stroke (3 [0.6%] vs. 9 [1.7%],P = 0.08) as compared with the Ramipril group.Conclusions: The use of ARB Losartan and ACEI Ramipril showed similar clinical efficacy and safety results up to 3 years in Korean AMI patients underwent PCI with DES.