The impact of angiotensin-converting-enzyme inhibitors versus angiotensin receptor blockers on 3-year clinical outcomes in patients with acute myocardial infarction without hypertension

Ae-Young Her,Seung-Woon Rha,Cheol Ung Choi,Byoung Geol Choi,Timir Paul,Myung Ho Jeong,Yong Hoon Kim

doi:10.1371/journal.pone.0242314

Abstract

This study aimed to investigate the impact of angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II type 1 receptor blockers (ARB) on 3-year clinical outcomes in acute myocardial infarction (AMI) patients without a history of hypertension who underwent successful percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 13,104 AMI patients who were registered in the Korea AMI registry (KAMIR)-National Institutes of Health (NIH) were included in the study. The primary endpoint was 3-year major adverse cardiac events (MACE), which was defined as the composite of all-cause death, recurrent myocardial infarction (MI), and any repeat revascularization. To adjust baseline potential confounders, an inverse probability weighting (IPTW) analysis was performed. The patients were divided into two groups: the ACEI group, n = 4,053 patients and the ARB group, n = 4,107 patients. During the 3-year clinical follow-up, the cumulative incidences of MACE (hazard ratio [HR], 0.843; 95% confidence interval [CI], 0.740–0.960; p = 0.010), any repeat revascularization (HR, 0.856; 95% CI, 0.736–0.995; p = 0.044), stroke (HR, 0.613; 95% CI, 0.417–0.901; p = 0.013), and re-hospitalization due to heart failure (HF) (HR, 0.399; 95% CI, 0.294–0.541; p <0.001) in the ACEI group were significantly lower than in the ARB group. In Korean patients with AMI without a history of hypertension, the use of ACEI was significantly associated with reduced incidences of MACE, any repeat revascularization, stroke, and re-hospitalization due to HF than those with the use of ARB.

Highlights

Secondary prevention of cardiovascular and cerebrovascular events, which includes optimal medical therapy, is extremely important in patients after acute myocardial infarction (AMI) because they remain at high risk for recurrent ischemic events [1, 2]
angiotensin-converting-enzyme inhibitors (ACEI) are indicated in non ST-segment elevation myocardial infarction (NSTEMI) patients with hypertension, systolic left ventricular dysfunction, heart failure (HF), or diabetes [5,6,7], in the absence of contraindications such as hypotension or severe renal dysfunction
The incidence of STEMI at final diagnosis was higher in the ACEI group (58.3 vs. 49.1%; p

Summary

Introduction

Secondary prevention of cardiovascular and cerebrovascular events, which includes optimal medical therapy, is extremely important in patients after acute myocardial infarction (AMI) because they remain at high risk for recurrent ischemic events [1, 2]. The current European guidelines recommend that treatment with angiotensin-converting-enzyme inhibitors (ACEI) should be considered in all patients with ST-segment elevation myocardial infarction (STEMI) [3, 4]. ACEI are indicated in non ST-segment elevation myocardial infarction (NSTEMI) patients with hypertension, systolic left ventricular dysfunction, heart failure (HF), or diabetes [5,6,7], in the absence of contraindications such as hypotension or severe renal dysfunction. The guidelines recommend that angiotensin II type 1 receptor blockers (ARB) should be considered as alternatives to ACEI, if patients cannot tolerate ACEI [3, 5]. Few studies have directly compared trials of ACEI and ARB in AMI patients without hypertension, and there is limited data on the relative superiority or similarity of the effects of ACEI and ARB on the long-term clinical outcomes in these patients

Objectives

Methods

Results

Conclusion