Angiotensin II type 1 receptor blockers as a first choice in patients with acute myocardial infarction
The Korean Journal of Internal Medicine
;
: 267-276, 2016.
Article
in English
| WPRIM
| ID: wpr-36004
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 > or = 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 14, 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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Recurrence
/
Stroke Volume
/
Time Factors
/
Angiotensin-Converting Enzyme Inhibitors
/
Chi-Square Distribution
/
Logistic Models
/
Proportional Hazards Models
/
Registries
/
Multivariate Analysis
/
Prospective Studies
Type of study:
Etiology study
/
Observational study
/
Prognostic study
/
Risk factors
Limits:
Humans
Country/Region as subject:
Asia
Language:
English
Journal:
The Korean Journal of Internal Medicine
Year:
2016
Type:
Article
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