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Comparative Effectiveness of Angiotensin II Receptor Blockers Versus Angiotensin-Converting Enzyme Inhibitors Following Contemporary Treatments in Patients with Acute Myocardial Infarction: Results from the Korean Working Group in Myocardial Infarction (KorMI) Registry

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Abstract

Background

There are few data on the comparative effectiveness of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) in a broad spectrum of patients with acute myocardial infarction (AMI), undergoing percutaneous coronary intervention (PCI).

Methods

A total of 8574 patients were selected from the prospective AMI registry, the Korean Working Group in Myocardial Infarction (KorMI) Registry, and divided into two groups on the basis of discharge prescription: ARB (n = 2281) or ACEI (n = 6293). The study was also designed using propensity-score matching (1171 patients in the ARB vs. 2752 patients in the ACEI group). The primary outcome was a composite of cardiac death or myocardial infarction (MI) during 1-year follow-up.

Results

The Cox model showed both the ARB and ACEI groups had similar risk of cardiac death or MI [adjusted hazard ratio (HR) for ARB 0.69, 95 % confidence interval (CI) 0.38–1.25, p = 0.22]. This result was consistent across various risk subgroups, including patients with preserved left ventricular systolic function, or according to the Global Registry of Acute Coronary Events (GRACE) risk scoring system. After propensity-score matching, there was no significant difference in the incidence of cardiac death or MI between the groups (1.3 % in the ARB group vs. 1.7 % in the ACEI group, adjusted HR for ARB 0.68, 95 % CI 0.38–1.23, p = 0.21). The risks of all-cause death, cardiac death, or MI were also similar between groups.

Conclusions

In a broad spectrum of AMI patients with interventional and pharmacologic treatments, the short-term risk of cardiac death or MI was similar between ARB and ACEI groups.

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Acknowledgments

The authors wish to thank all the Korean Working Group in Myocardial Infarction Registry study investigators.

Additional contributions

We thank the excellent statistical support of Seonwoo Kim, PhD, and Joonghyun Ahn, MS, at the Samsung Biomedical Research Institute.

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    Authors and Affiliations

    1. Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, #875, Haeundae-ro, Haeundae-gu, Busan, 612-896, Republic of Korea

      Pil Sang Song, Sang-Hoon Seol, Guang-Won Seo, Dong-Kie Kim, Ki-Hun Kim & Doo-Il Kim

    2. Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea

      Jeong Hoon Yang, Joo-Yong Hahn, Hyeon-Cheol Gwon & Young Bin Song

    3. Department of Cardiovascular Medicine, Chonnam National University College of Medicine, Gwangju, Republic of Korea

      Youngkeun Ahn & Myung Ho Jeong

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    1. Pil Sang Song
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    Corresponding authors

    Correspondence to Young Bin Song or Doo-Il Kim.

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    Funding

    This research was supported by grants from the Korean Society of Cardiology and the Korean Health Technology R&D Project, Ministry of Health & Welfare (HI13C1527), Republic of Korea.

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    None.

    Additional information

    P. S. Song and S.-H. Seol have contributed equally to this study.

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    Song, P.S., Seol, SH., Seo, GW. et al. Comparative Effectiveness of Angiotensin II Receptor Blockers Versus Angiotensin-Converting Enzyme Inhibitors Following Contemporary Treatments in Patients with Acute Myocardial Infarction: Results from the Korean Working Group in Myocardial Infarction (KorMI) Registry. Am J Cardiovasc Drugs 15, 439–449 (2015). https://doi.org/10.1007/s40256-015-0140-5

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