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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.
Subject(s)

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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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