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Comparison of clinical outcomes between angiotensin-converting-enzyme inhibitors and ARBs in patients with acute myocardial infarction with dyslipidemia after a successful stent implantation [Anatol J Cardiol]
Anatol J Cardiol. 2020; 23(2): 86-98 | DOI: 10.14744/AnatolJCardiol.2019.60374  

Comparison of clinical outcomes between angiotensin-converting-enzyme inhibitors and ARBs in patients with acute myocardial infarction with dyslipidemia after a 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-South Korea
2Department of Cardiology, Chonnam National University Hospital; Gwangju-South Korea
3Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine; Seoul-South Korea
4Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital; Busan-South Korea

Objective: Currently, there are limited comparative data concerning long-term major clinical outcomes following the angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin II type 1 (AT1) receptor blockers (ARBs) therapy in patients with acute myocardial infarction (AMI) with dyslipidemia after a successful stent implantation. Therefore, we investigated major clinical outcomes for 2 years following the ACEIs and ARBs therapy in these patients.
Methods: A total of 3015 patients with AMI who underwent a successful stent implantation and were prescribed ACEIs (n=2175) or ARBs (n=840) were enrolled into the study 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 the 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), 1.1544.495; p=0.018]. The cumulative incidences of MACEs (aHR, 1.305; 95% CI, 0.9111.869; p=0.146), cardiac death, Re-MI, any repeat revascularization, TLR, TVR, and non-TVR were similar between the two groups. In addition, an advanced 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 a preferred treatment modality when compared to ARBs for patients with AMI with dyslipidemia who underwent a successful stent implantation to reduce the incidences of all-cause death during a 2-year follow-up. However, additional research is required to determine the clinical implications of these results.

Keywords: dyslipidemia, myocardial infarction, renin-angiotensin system


Yong Hoon Kim, Ae-young Her, Myung Ho Jeong, Byeong-keuk Kim, Sung-jin Hong, Seunghwan Kim, Chul-min Ahn, Jung-sun Kim, Young-guk Ko, Donghoon Choi, Myeong-ki Hong, Yangsoo Jang. Comparison of clinical outcomes between angiotensin-converting-enzyme inhibitors and ARBs in patients with acute myocardial infarction with dyslipidemia after a successful stent implantation. Anatol J Cardiol. 2020; 23(2): 86-98

Corresponding Author: Yong Hoon Kim, South Korea


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