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Korean J Intern Med. 2016 Mar;31(2):267-76. doi: 10.3904/kjim.2014.268. Epub 2015 Dec 23.

Angiotensin II type 1 receptor blockers as a first choice in patients with acute myocardial infarction.

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Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea.
Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center, Seoul, Korea.



Angiotensin II type 1 receptor blockers (ARBs) have not been adequately evaluated in patients without left ventricular (LV) dysfunction or heart failure after acute myocardial infarction (AMI).


Between November 2005 and January 2008, 6,781 patients who were not receiving angiotensin-converting enzyme inhibitors (ACEIs) or ARBs were selected from the Korean AMI Registry. The primary endpoints were 12-month major adverse cardiac events (MACEs) including death and recurrent AMI.


Seventy percent of the patients were Killip class 1 and had a LV ejection fraction ≥ 40%. The prescription rate of ARBs was 12.2%. For each patient, a propensity score, indicating the likelihood of using ARBs during hospitalization or at discharge, was calculated using a non-parsimonious multivariable logistic regression model, and was used to match the patients 1:4, yielding 715 ARB users versus 2,860 ACEI users. The effect of ARBs on in-hospital mortality and 12-month MACE occurrence was assessed using matched logistic and Cox regression models. Compared with ACEIs, ARBs significantly reduced in-hospital mortality(1.3% vs. 3.3%; hazard ratio [HR], 0.379; 95% confidence interval [CI], 0.190 to0.756; p = 0.006) and 12-month MACE occurrence (4.6% vs. 6.9%; HR, 0.661; 95% CI, 0.457 to 0.956; p = 0.028). However, the benefit of ARBs on 12-month mortality compared with ACEIs was marginal (4.3% vs. 6.2%; HR, 0.684; 95% CI, 0.467 to 1.002; p = 0.051).


Our results suggest that ARBs are not inferior to, and may actually be better than ACEIs in Korean patients with AMI.


Angiotensin II type 1 receptor blockers; Angiotensin-converting enzyme inhibitors; Mortality; Myocardial infarction; Secondary prevention

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