Abstract
BackgroundCurrent guidelines recommend angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) or β-blockers (β-B) for secondary prevention in patients after an acute myocardial infarction (AMI). However, there is limited data to evaluate ACEI/ARB/β-B (AAβ) used before AMI on major adverse cardiovascular events (MACE), in China patients.ObjectivesThis study sought to investigate whether AAβ treatment prior to AMI is associated with better hospital outcomes at the onset of AMI.MethodsA total of 2705 patients were selected from the Cardiovascular Center Beijing Friendship Hospital Database Bank, and divided into two groups on the basis of admission prescription: AAβ (n = 872) or no-AAβ (n = 1833). The study was also designed using propensity-score matching (226 AAβ treated patients vs 452 no-AAβ treated patients). The primary outcome was a composite of cardiac death and heart function and infarct size during hospitalization follow-up.ResultsThe mean follow-up period was about 8 days in MACE. The Cox model showed the two groups had similar risk of cardiac death. The in-hospital mortality was 3.36% (3.33% of AAβ users and 3.38% of nonusers, p = 0.94). In adjusted analysis, there was still no difference in in-hospital mortality between the two groups (3.54% vs 2.88%, p = 0.64). However, the AAβ treated patients were associated with better heart function and smaller infarct size than the no-AAβ treated patients.ConclusionsThe in-hospital MACE was similar between AAβ treated patients and no-AAβ treated patients. However, treatment with AAβ before AMI was associated with improved heart function and smaller infarct size.
Highlights
Current guidelines recommend angiotensin-converting-enzyme inhibitors (ACEI) or angiotensinreceptor blockers (ARB) or β-blockers (β-B) for secondary prevention in patients after an acute myocardial infarction (AMI)
Treatment with AAβ before AMI was associated with improved heart function and smaller infarct size
A large number of clinical trials have found that angiotensin-converting enzyme inhibitors (ACEIs), Angiotensin-receptor blockers (ARBs) and β-blockers (β-B) prevented ischemic events and mortality in patients with AMI [2,3,4]
Summary
Current guidelines recommend angiotensin-converting-enzyme inhibitors (ACEI) or angiotensinreceptor blockers (ARB) or β-blockers (β-B) for secondary prevention in patients after an acute myocardial infarction (AMI). There is limited data to evaluate ACEI/ARB/β-B (AAβ) used before AMI on major adverse cardiovascular events (MACE), in China patients. With the development of China’s economy, the number of patients with acute myocardial infarction (AMI) increases year by year in China, and the overall mortality rate is on the rise [1]. A large number of clinical trials have found that angiotensin-converting enzyme inhibitors (ACEIs), Angiotensin-receptor blockers (ARBs) and β-blockers (β-B) prevented ischemic events and mortality in patients with AMI [2,3,4]. Secondary prevention protocols including these agents are regarded to be standard therapy following an AMI, along with aspirin and statins [5, 6]. There is no doubt that ACEI/ARB/β-blocker (AAβ) offer the most benefit to AMI patients, there is still uncertainty about prescribing these agents to a real population of patients before AMI occurs
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