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Anatol J Cardiol. 2020 Jan;23(2):86-98. doi: 10.14744/AnatolJCardiol.2019.60374.

Comparison of clinical outcomes between angiotensin-converting-enzyme inhibitors and ARBs in patients with acute myocardial infarction with dyslipidemia after a successful stent implantation.

Author information

1
Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine; Chuncheon-South Korea.
2
Department of Cardiology, Chonnam National University Hospital; Gwangju-South Korea.
3
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine; Seoul-South Korea.
4
Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital; Busan-South Korea.

Abstract

OBJECTIVE:

Currently, there are limited comparative data concerning long-term major clinical outcomes following the angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin II type 1 (AT1) receptor blockers (ARBs) therapy in patients with acute myocardial infarction (AMI) with dyslipidemia after a successful stent implantation. Therefore, we investigated major clinical outcomes for 2 years following the ACEIs and ARBs therapy in these patients.

METHODS:

A total of 3015 patients with AMI who underwent a successful stent implantation and were prescribed ACEIs (n=2175) or ARBs (n=840) were enrolled into the study from the Korea AMI Registry (KAMIR). The major clinical endpoint was the occurrence of major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat-revascularization-comprised target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR.

RESULTS:

After the adjustment, the cumulative incidence of all-cause death in the ARBs group was significantly higher than in the ACEIs group [adjusted hazard ratio (aHR), 2.277; 95% confidence interval (CI), 1.154-4.495; p=0.018]. The cumulative incidences of MACEs (aHR, 1.305; 95% CI, 0.911-1.869; p=0.146), cardiac death, Re-MI, any repeat revascularization, TLR, TVR, and non-TVR were similar between the two groups. In addition, an advanced age (≥65 years), decreased left ventricular ejection fraction (<50%), and cardiopulmonary resuscitation on admission were meaningful independent predictors for all-cause death in this study.

CONCLUSION:

ACEIs were a preferred treatment modality when compared to ARBs for patients with AMI with dyslipidemia who underwent a successful stent implantation to reduce the incidences of all-cause death during a 2-year follow-up. However, additional research is required to determine the clinical implications of these results.

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