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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.

Author information

1
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
2
Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
3
Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
4
Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
5
Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea.
6
Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center, Seoul, Korea.

Abstract

BACKGROUND/AIMS:

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).

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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

KEYWORDS:

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

PMID:
26701233
PMCID:
PMC4773713
DOI:
10.3904/kjim.2014.268
[Indexed for MEDLINE]
Free PMC Article

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