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Comparison of clinical outcomes between ACE inhibitor and ARB in AMI patients with dyslipidemia after successful stent implantation [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-60374 | DOI: 10.14744/AnatolJCardiol.2019.60374  

Comparison of clinical outcomes between ACE inhibitor and ARB in AMI patients with dyslipidemia after successful stent implantation

Yong Hoon Kim1, Ae-young Her1, Myung Ho Jeong2, Byeong-keuk Kim3, Sung-jin Hong3, Seunghwan Kim4, Chul-min Ahn3, Jung-sun Kim3, Young-guk Ko3, Donghoon Choi3, Myeong-ki Hong3, Yangsoo Jang3
1Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon
2Department of Cardiology, Chonnam National University Hospital, Gwangju
3Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul
4Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea

Objective: Thus far, there are limited comparative data concerning long-term major clinical outcomes following angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) therapy in acute myocardial infarction (AMI) patients with dyslipidemia after successful stent implantation. Therefore, we investigated the 2-year major clinical outcomes following ACEIs and ARBs therapy in these patients.
Methods: A total of 3015 AMI patients who underwent successful stent implantation and had been prescribed ACEIs (n=2175) or ARBs (n=840) were enrolled from the Korea AMI Registry (KAMIR). The major clinical endpoint was the occurrence of major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization comprised target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR.
Results: After adjustment, the cumulative incidence of all-cause death in the ARBs group was significantly higher than in the ACEIs group (adjusted hazard ratio [aHR], 2.277; 95% confidence interval [CI], 1.154-4.495; p=0.018). The cumulative incidences of MACEs (aHR, 1.305; 95% CI, 0.911-1.869; p=0.146), cardiac death, Re-MI, any repeat revascularization, TLR, TVR, and non-TVR were similar between the two groups. In addition, old age (≥65 years), decreased left ventricular ejection fraction (<50%), and cardiopulmonary resuscitation on admission were meaningful independent predictors for all-cause death in this study.
Conclusion: ACEIs were the preferred treatment modality rather than ARBs for AMI patients with dyslipidemia who underwent successful stent implantation, to reduce the incidences of all-cause death during a 2-year follow-up period. However, additional research is needed to determine the clinical implications of these results.

Keywords: Dyslipidemia, Myocardial infarction, Renin-angiotensin system

Corresponding Author: Yong Hoon Kim, South Korea

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