Abstract
For the Asian patients with STEMI undergoing PCI, ACEIs are known to have a better outcome than ARBs. However, there is limited evidence to suggest so. Among the STEMI registry consist of 1142 Korean patients, we compared the MACE, the composite of myocardial infarction, stoke, death, admission for heart failure, and target vessel revascularization, between the ACEI and ARB groups (Set 1). Further, we defined adequate medication as the administration of a dose equal to or higher than the initiation dose of ACEI according to the heart failure guideline recommendation with a mandatory addition of beta-blockers, and compared the outcomes between the inadequate and adequate medication groups (Set 2). Propensity score matching was used to eliminate difference. In the Set 1 comparison, patients in the ACEI group had a better outcome than those in the ARB group for both whole and matched populations (whole and matched population: Cox regression hazard ratio [HR], 0.645 and 0.535; 95% confidence interval [CI], 0.440-0.944 and 0.296-0.967; p = 0.024 and p = 0.039, respectively). In the Set 2 comparison for the whole population, patients in the inadequate medication group had more MACE than those in the adequate medication group (HR, 0.673; 95% CI, 0.459-0.985; p = 0.042). However, no difference was observed after propensity score matching (HR, 1.023; 95% CI, 0.654-1.602; p = 0.919). ACEIs might be a better choice than ARBs after primary revascularization. However, this study's findings suggest that early ACEI dose escalation combined with beta-blocker use may not improve prognosis.
Highlights
The clinical benefit of angiotensin-converting enzyme inhibitors (ACEIs) in patients with myocardial infarction (MI) is well-known [1]
With the development of new angiotensin receptor blocker (ARB) and reports of their better efficacy, there is a growing expectation that ARB treatment would result in a better prognosis than ACEI treatment for patients with segment elevation MI (STEMI)
Byun et al [6], reported that ACEI use was associated with a two-year reduction in major adverse cerebrovascular and cardiovascular events (MACE) and revascularization rates for NSTEMI and DM patients
Summary
The clinical benefit of angiotensin-converting enzyme inhibitors (ACEIs) in patients with myocardial infarction (MI) is well-known [1]. Angiotensin receptor blockers (ARBs) were introduced after ACEI, have a similar pathway of blocking the renin-angiotensin-aldosterone system (RAAS), and are permitted alternatives for use in patients with MI. Their role in MI has been studied in large-scale randomized controlled trials (RCTs) [2,3]. We defined adequate medication as the administration of a dose equal to or higher than the initiation dose of ACEI according to the heart failure guideline recommendation with a mandatory addition of beta-blockers, and compared the outcomes between the inadequate and adequate medication groups (Set 2). This study’s findings suggest that early ACEI dose escalation combined with beta-blocker use may not improve prognosis
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