Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization

Hui Wen Sim,Khung-Keong Yeo,Mark Y Chan,Tiong Cheng Yeo,Anders Sahlen,Huay Cheem Tan,Terrance Chua,Jack W Tan,Boon-Wah Liew,Hee Hwa Ho,Huili Zheng,Ruth W Chen,A Mark Richards,Chi-Hang Lee,Derek J Hausenloy,Ling Li Foo

doi:10.1038/s41598-020-72232-y

Abstract

Pivotal trials of beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) in acute myocardial infarction (AMI) were largely conducted prior to the widespread adoption of early revascularization. A total of 15,073 patients with AMI who underwent inhospital coronary revascularization from January 2007 to December 2013 were analyzed. At 12 months, BB was significantly associated with a lower incidence of major adverse cardiovascular events (MACE, adjusted HR 0.80, 95% CI 0.70–0.93) and all-cause mortality (adjusted HR 0.69, 95% CI 0.55–0.88), while ACEI/ARB was significantly associated with lower all-cause mortality (adjusted HR 0.80, 95% CI 0.66–0.98) and heart failure (HF) hospitalization (adjusted HR 0.80, 95% CI 0.68–0.95). Combined BB and ACEI/ARB use was associated with the lowest incidence of MACE (adjusted HR 0.70, 95% CI 0.57–0.86), all-cause mortality (adjusted HR 0.55, 95% CI 0.40–0.77) and HF hospitalization (adjusted HR 0.64, 95% CI 0.48–0.86). This were consistent for left ventricular ejection fraction < 50% or ≥ 50%. In conclusion, in AMI managed with revascularization, both BB and ACEI/ARB were associated with a lower incidence of 12-month all-cause mortality. Combined BB and ACEI/ARB was associated with the lowest incidence of all-cause mortality and HF hospitalization.

Highlights

Pivotal trials of beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) in acute myocardial infarction (AMI) were largely conducted prior to the widespread adoption of early revascularization
Combined BB and ACEI/ARB use was associated with the lowest incidence of major adverse cardiovascular events (MACE), all-cause mortality and heart failure (HF) hospitalization
BB and ACEI/ARB may confer additive effects on survival in patients with AMI via different mechanisms: BB inhibits sympathetic activity and guards against arrhythmic deaths while ACEI/ARB modifies cardiac remodelling and reduces HF mortality[20]. In this contemporary cohort of patients with AMI undergoing inhospital revascularization, we observed that prescription of either BB or ACEI/ARB at discharge was associated with a lower incidence of 12-month all-cause mortality compared with patients who received neither drug at discharge, even after adjusting for relevant confounding variables

Summary

Introduction

Pivotal trials of beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) in acute myocardial infarction (AMI) were largely conducted prior to the widespread adoption of early revascularization. Combined BB and ACEI/ARB use was associated with the lowest incidence of MACE (adjusted HR 0.70, 95% CI 0.57–0.86), all-cause mortality (adjusted HR 0.55, 95% CI 0.40–0.77) and HF hospitalization (adjusted HR 0.64, 95% CI 0.48–0.86). This were consistent for left ventricular ejection fraction < 50% or ≥ 50%. We evaluated the association of BB and ACEI/ARB with 12-month mortality, HF hospitalization and MI in patients with AMI who had undergone inhospital coronary revascularization

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Discussion

Conclusion