Key result
Angiotensin receptor blockers were associated with a higher risk of major cardiovascular events compared to ACE inhibitors in NSTEMI patients with preserved LV function.
Why the study?
The relative superiority of ACEIs and ARBs on long-term clinical outcomes in patients with NSTEMI with preserved left ventricular systolic function in the era of new-generation drug-eluting stents was not well established.
Do ACE inhibitors reduce major adverse cardiac events compared to ARBs in patients with NSTEMI and preserved LV systolic function who underwent PCI with new generation drug-eluting stents?
Cohort (n=6,436)
Do ACE inhibitors reduce major adverse cardiac events compared to ARBs in patients with NSTEMI and preserved LV systolic function who underwent PCI with new generation drug-eluting stents?
In patients with NSTEMI and preserved LV systolic function undergoing PCI with new-generation DES, ACE inhibitors were associated with a lower risk of MACEs, driven by reduced repeat revascularization, compared to ARBs over 2 years.
Answers are grounded in this paper and cite their sources.
May support ACE inhibitors over ARBs in NSTEMI with preserved function post-PCI; hypothesis-generating, requires RCTs before practice change.
The relative superiority of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) with preserved left ventricular systolic function in the era of new generation drug-eluting stents is not well established. A total of 6436 patients with NSTEMI (ACEIs group: n = 3965 vs ARBs group: n = 2471) were enrolled. The major clinical end point was the occurrences of major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction (re-MI), and any repeat revascularization. After propensity score matching analysis, the cumulative incidences of MACEs (hazard ratio, 1.334; 95% confidence interval, 1.045-1.703; P = .021), any repeat revascularization, and target vessel revascularization (TVR) in the ARB group were significantly higher than that in the ACEI group. However, the cumulative incidences of all-cause death, cardiac death, re-MI, target lesion revascularization, and non-TVR were similar between the 2 groups. Hence, although the mortality and re-MI reduction benefits were similar between the 2 groups, the ACEIs group showed more prominent ability to decrease the occurrences of MACEs, any repeat revascularization, and TVR compared to the ARBs group in these patients during a 2-year follow-up period.
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Kim et al. (2019) conducted a cohort in NSTEMI with preserved left ventricular systolic function (n=6,436). Angiotensin receptor blockers (ARBs) vs. Angiotensin-converting enzyme inhibitors (ACEIs) was evaluated on Major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction, and any repeat revascularization (HR 1.334, 95% CI 1.045-1.703, p=0.021). Angiotensin receptor blockers were associated with a higher risk of major cardiovascular events compared to ACE inhibitors in NSTEMI patients with preserved LV function.
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