Skip to main content
SpringerLink
Log in

Comparison Between Beta-Blockers with Angiotensin-Converting Enzyme Inhibitors and Beta-Blockers with Angiotensin II Type I Receptor Blockers in ST-Segment Elevation Myocardial Infarction After Successful Percutaneous Coronary Intervention with Drug-Eluting Stents

  • ORIGINAL ARTICLE
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Background/Aims

Limited comparative data concerning long-term clinical outcomes of combination therapy between beta-blockers (BB) with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) therapy in patients with ST-segment elevation myocardial infarction (STEMI) are available. We thought to compare 2-year major clinical outcomes between BB with ACEI and BB with ARB therapy in patients with STEMI after successful percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

Methods

13,873 STEMI patients who underwent successful PCI with DES were enrolled and divided into two groups as the BB with ACEI group (n = 10,393) and the BB with ARB group (n = 3480). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, cardiac death (CD), recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during the 2-year follow-up period.

Results

After propensity score-matched (PSM) analysis, two PSM groups (3296 pairs, n = 6592, C-statistic = 0.675) were generated. Although the incidences of re-MI, TLR, and TVR were similar, the incidences of MACE (8.3% vs. 6.8%, log-rank p = 0.038, hazard ratio [HR] 1.210, 95% confidence interval [CI] 1.010–1.451, p = 0.039), all-cause death, CD, total revascularization, and non-TVR of the BB with ARB group were significantly higher than the BB with ACEI group after PSM. In addition, diabetes and multivessel disease were significant predictors for non-TVR.

Conclusions

The combination BB with ACEI may be beneficial for reducing MACE in STEMI patients after successful PCI with DES than the BB with ARB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

AMI:

Acute myocardial infarction

STEMI:

ST-segment elevation myocardial infarction

DES:

Drug-eluting stent

EES:

Everolimus-eluting stent

MACE:

Major adverse cardiac event

PCI:

Percutaneous coronary intervention

PES:

Paclitaxel-eluting stent

SES:

Sirolimus-eluting stent

TLR:

Target lesion revascularization

TVR:

Target vessel revascularization

Non-TVR:

Non-target vessel revascularization

ZES:

Zotarolimu-eluting stent

References

  1. American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions, O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78–140.

    Google Scholar 

  2. Freemantle N, Cleland J, Young P, Mason J, Harrison J. Beta-blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999;318:1730–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119–77.

    Article  Google Scholar 

  4. Cleland JG, Erhardt L, Murray G, Hall AS, Ball SG. Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure. A report from the AIRE Study Investigators. Eur Heart J. 1997;18:41–51.

    Article  CAS  PubMed  Google Scholar 

  5. Nishino T, Furukawa Y, Kaji S, Ehara N, Shiomi H, Kim K, et al. Distinct survival benefits of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in revascularized coronary artery disease patients according to history of myocardial infarction. Circ J. 2013;77:1242–52.

    Article  CAS  PubMed  Google Scholar 

  6. Pfeffer MA, McMurray J, Leizorovicz A, Maggioni AP, Rouleau JL, Van De Werf F, et al. Valsartan in acute myocardial infarction trial (VALIANT): rationale and design. Am Heart J. 2000;140:727–50.

    Article  CAS  PubMed  Google Scholar 

  7. Yang JH, Hahn JY, Song YB, Choi SH, Choi JH, Lee SH, et al. Angiotensin receptor blocker in patients with ST segment elevation myocardial infarction with preserved left ventricular systolic function: prospective cohort study. BMJ. 2014;349:g6650.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:e362–425.

    PubMed  Google Scholar 

  9. López-Sendón J, Swedberg K, McMurray J, Tamargo J, Maggioni AP, Dargie H, et al. Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J. 2004;25:1341–62.

    Article  PubMed  Google Scholar 

  10. Smith SC Jr, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, et al. AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation. 2001;104:1577–9.

    Article  PubMed  Google Scholar 

  11. Chen ZM, Panc HC, Chen YP, Peto R, Collins R, Jiang LX, Xie JX, Liu LS; COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomized placebo-controlled trial. Lancet. 2005;366:1622–32.

  12. Pfisterer M, Cox JL, Granger CB, Brener SJ, Naylor CD, Califf RM, et al. Atenolol use and clinical outcomes after thrombolysis for acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries. J Am Coll Cardiol. 1998;32:634–40.

    Article  CAS  PubMed  Google Scholar 

  13. Andersson C, Shilane D, Go AS, Chang TI, Kazi D, Solomon MD, et al. β-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease. J Am Coll Cardiol. 2014;64:247–52.

    Article  CAS  PubMed  Google Scholar 

  14. Ball SG, Hall AS, Murray GD. ACE inhibition, atherosclerosis and myocardial infarction—the AIRE Study in practice. Acute Infarction Ramipril Efficacy Study. Eur Heart J. 1994;15(Suppl B):20–5 discussion 26–30.

    Article  PubMed  Google Scholar 

  15. Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ Jr, Cuddy TE, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE investigators. N Engl J Med. 1992;327:669–77.

    Article  CAS  PubMed  Google Scholar 

  16. Flather MD, Yusuf S, Kober L, Pfeffer M, Hall A, Murray G, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet. 2000;355:1575–81.

    Article  CAS  PubMed  Google Scholar 

  17. Probstfield JL, O'Brien KD. Progression of cardiovascular damage: the role of renin-angiotensin system blockade. Am J Cardiol. 2010;105:10a–20a.

    Article  CAS  PubMed  Google Scholar 

  18. Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet. 2000;355:253–9.

    Article  Google Scholar 

  19. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993;342:821–8.

    Google Scholar 

  20. Strauss MH, Hall AS. Angiotensin receptor blockers may increase risk of myocardial infarction: unraveling the ARB-MI paradox. Circulation. 2006;114:838–54.

    Article  PubMed  Google Scholar 

  21. Verma S, Strauss M. Angiotensin receptor blockers and myocardial infarction. BMJ. 2004;329:1248–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ramchand J, Patel SK, Srivastava PM, Farouque O, Burrell LM. Elevated plasma angiotensin converting enzyme 2 activity is an independent predictor of major adverse cardiac events in patients with obstructive coronary artery disease. PLoS One. 2018;13:e0198144.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Park H, Kim HK, Jeong MH, Cho JY, Lee KH, Sim DS, et al. Clinical impacts of inhibition of renin-angiotensin system in patients with acute ST-segment elevation myocardial infarction who underwent successful late percutaneous coronary intervention. J Cardiol. 2017;69:216–21.

    Article  PubMed  Google Scholar 

  24. Zweifler A, Esler M. Blood pressure, renin activity and heart rate changes during propranolol therapy of hypertension. Am J Cardiol. 1977;40:105–9.

    Article  CAS  PubMed  Google Scholar 

  25. Konishi M, Haraguchi G, Yoshikawa S, Kimura S, Inagaki H, Isobe M. Additive effects of beta-blockers on renin-angiotensin system inhibitors for patients after acute myocardial infarction treated with primary coronary revascularization. Circ J. 2011;75:1982–91.

    Article  CAS  PubMed  Google Scholar 

  26. Savarese G, Costanzo P, Cleland JG, Vassallo E, Ruggiero D, Rosano G, et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Cardiol. 2013;61:131–42.

    Article  CAS  PubMed  Google Scholar 

  27. Lee PH, Park GM, Kim YH, Yun SC, Chang M, Roh JH, et al. Effect of beta blockers and renin-angiotensin system inhibitors on survival in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Medicine (Baltimore). 2016;95:e2971.

    Article  CAS  Google Scholar 

  28. McMurray J, Solomon S, Pieper K, Reed S, Rouleau J, Velazquez E, et al. The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). J Am Coll Cardiol. 2006;47:726–33.

    Article  CAS  PubMed  Google Scholar 

  29. Spitaleri G, Moscarella E, Brugaletta S, Pernigotti A, Ortega-Paz L, Gomez-Lara J, et al. Correlates of non-target vessel-related adverse events in patients with ST-segment elevation myocardial infarction: insights from five-year follow-up of the EXAMINATION trial. EuroIntervention. 2018;13:1939–45.

    Article  PubMed  Google Scholar 

  30. Hong MK, Mintz GS, Lee CW, Kim YH, Lee SW, Song JM, et al. Comparison of coronary plaque rupture between stable angina and acute myocardial infarction: a three-vessel intravascular ultrasound study in 235 patients. Circulation. 2004;110:928–33.

    Article  PubMed  Google Scholar 

  31. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364:226–35.

    Article  CAS  PubMed  Google Scholar 

  32. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367:2375–84.

    Article  CAS  Google Scholar 

  33. Jimenez-Quevedo P, Hernando L, Gomez-Hospital JA, Iñiguez A, SanRoman A, Alfonso F, et al. Sirolimus-eluting stent versus bare metal stent in diabetic patients: the final five-year follow-up of the DIABETES trial. EuroIntervention. 2013;9:328–35.

    Article  PubMed  Google Scholar 

  34. Park DW, Clare RM, Schulte PJ, Pieper KS, Shaw LK, Califf RM, et al. Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction. JAMA. 2014;312:2019–27.

    Article  CAS  PubMed  Google Scholar 

  35. Jaski BE, Cohen JD, Trausch J, Marsh DG, Bail GR, Overlie PA, et al. Outcome of urgent percutaneous transluminal coronary angioplasty in acute myocardial infarction: comparison of single-vessel versus multivessel coronary artery disease. Am Heart J. 1992;124:1427–33.

    Article  CAS  PubMed  Google Scholar 

  36. Westreich D, Cole SR, Funk MJ, Brookhart MA, Sturmer T. The role of the c-statistic in variable selection for propensity score models. Pharmacoepidemiol Drug Saf. 2011;20:317–20.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Korea Acute Myocardial infarction Registry (KAMIR) investigators.

Myung Ho Jeong, MD; Youngkeun Ahn, MD; Sung Chul Chae, MD; Jong Hyun Kim, MD; Seung-Ho Hur, MD; Young Jo Kim, MD; In Whan Seong, MD; Donghoon Choi, MD; Jei Keon Chae, MD; Taek Jong Hong, MD; Jae Young Rhew, MD; Doo-Il Kim, MD; In-Ho Chae, MD; Jung Han Yoon, MD; Bon-Kwon Koo, MD; Byung-Ok Kim, MD; Myoung Yong Lee, MD; Kee-Sik Kim, MD; Jin-Yong Hwang, MD; Myeong Chan Cho, MD; Seok Kyu Oh, MD; Nae-Hee Lee, MD; Kyoung Tae Jeong, MD; Seung-Jea Tahk, MD; Jang-Ho Bae, MD; Seung-Woon Rha, MD; Keum-Soo Park, MD; Chong Jin Kim, MD; Kyoo-Rok Han, MD; Tae Hoon Ahn, MD; Moo-Hyun Kim, MD; Ki Bae Seung, MD; Wook Sung Chung, MD; Ju-Young Yang, MD; Chong Yun Rhim, MD; Hyeon-Cheol Gwon, MD; Seong-Wook Park, MD; Young-Youp Koh, MD; Seung Jae Joo, MD; Soo-Joong Kim, MD; Dong Kyu Jin, MD; Jin Man Cho, MD; Sang-Wook Kim, MD; Jeong Kyung Kim, MD; Tae Ik Kim, MD; Deug Young Nah, MD; Si Hoon Park, MD; Sang Hyun Lee, MD; Seung Uk Lee, MD; Hang-Jae Chung, MD; Jang-Hyun Cho, MD; Seung Won Jin, MD; Myeong-Ki Hong, MD; Yangsoo Jang, MD; Jeong Gwan Cho, MD; Hyo-Soo Kim, MD; and Seung Jung Park, MD.

Funding

This research was supported by a fund (2016-ER6304-02) by Research of Korea Centers for Disease Control and Prevention.

Author information

Author notes

  1. Yong Hoon Kim and Ae-Young Her contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, 24289, 156 Baengnyeong Road, Chuncheon, Gangwon Province, South Korea

    Yong Hoon Kim & Ae-Young Her

  2. Chonnam National University Hospital, Gwangju, South Korea

    Myung Ho Jeong

  3. Division of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, Seoul, South Korea

    Byeong-Keuk Kim, Sung-Jin Hong, Dong-Ho Shin, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong & Yangsoo Jang

  4. Sanbon Hospital, College of Medicine, Wonkwang University, Gunpo, South Korea

    Seung-Yul Lee

Authors
  1. Yong Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ae-Young Her
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Myung Ho Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byeong-Keuk Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seung-Yul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sung-Jin Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dong-Ho Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jung-Sun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Young-Guk Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Donghoon Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Myeong-Ki Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yangsoo Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Hoon Kim.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, Y.H., Her, AY., Jeong, M.H. et al. Comparison Between Beta-Blockers with Angiotensin-Converting Enzyme Inhibitors and Beta-Blockers with Angiotensin II Type I Receptor Blockers in ST-Segment Elevation Myocardial Infarction After Successful Percutaneous Coronary Intervention with Drug-Eluting Stents. Cardiovasc Drugs Ther 33, 55–67 (2019). https://doi.org/10.1007/s10557-018-6841-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10557-018-6841-7

Keywords

Search

Navigation