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Comparative Study
. 2014 Nov 14:349:g6650.
doi: 10.1136/bmj.g6650.

Angiotensin receptor blocker in patients with ST segment elevation myocardial infarction with preserved left ventricular systolic function: prospective cohort study

Jeong Hoon Yang  1 , Joo-Yong Hahn  2 , Young Bin Song  3 , Seung-Hyuk Choi  3 , Jin-Ho Choi  3 , Sang Hoon Lee  3 , Myung-Ho Jeong  4 , Dong-Joo Choi  5 , Jong Seon Park  6 , Hun Sik Park  7 , Hyeon-Cheol Gwon  3
Affiliations
Comparative Study

Angiotensin receptor blocker in patients with ST segment elevation myocardial infarction with preserved left ventricular systolic function: prospective cohort study

Jeong Hoon Yang et al. BMJ. .

Abstract

Objective: To investigate the association between treatment with an angiotensin receptor blocker and clinical outcomes in patients with ST segment elevation myocardial infarction with preserved left ventricular systolic function.

Design: A prospective cohort study using data from a nationwide large scale registry.

Setting: 53 hospitals involved in treatment of acute myocardial infarction in Korea.

Participants: Between November 2005 and September 2010, we studied 6698 patients with ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and had a left ventricular ejection fraction ≥ 40%.

Main outcome measures: Cardiac death or myocardial infarction. Patients were divided into an angiotensin receptor blocker group (n=1185), an angiotensin converting enzyme (ACE) inhibitor group (n=4564), and a group who did not receive any renin angiotensin system blocker (n=949). Propensity score matching analysis was also performed.

Results: Cardiac death or myocardial infarction occurred in 21 patients (1.8%) in the angiotensin receptor blocker group, 77 patients (1.7%) in the ACE inhibitor group, and 33 patients (3.5%) in the no renin angiotensin system blocker group. After propensity score matching (1175 pairs), there was no significant difference in the rate of cardiac death or myocardial infarction between the angiotensin receptor blocker group and ACE inhibitor group (21 (1.8%) v 23 (2.0%), adjusted hazard ratio 0.65, 95% confidence interval 0.30 to 1.38; P=0.65). The angiotensin receptor blocker group had a lower rate of cardiac death or myocardial infarction than the no renin angiotensin system blocker group in matched populations (803 pairs) (14 (1.7%) v 25 (3.1%), 0.35, 0.14 to 0.90; P=0.03).

Conclusion: Angiotensin receptor blocker showed beneficial effects comparable with ACE inhibitors in patients with ST segment elevation myocardial infarction with preserved left ventricular systolic function. Angiotensin receptor blockers could be used as an alternative to ACE inhibitors in such patients.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Group distribution in registry. KAMIR=Korean Acute Myocardial Infarction Registry, MI=myocardial infarction, STEMI=ST segment elevation myocardial infarction, NSTEMI=non-ST segment elevation myocardial infarction, ARB=angiotensin receptor blocker, No RAS=no renin angiotensin system blocker, LVEF=left ventricular ejection fraction
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Fig 2 Kaplan-Meier curves for cardiac death or myocardial infarction (MI) with angiotensin receptor blocker (ARB) compared with ACE inhibitor in overall population and propensity matched population
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Fig 3 Kaplan-Meier curves for cardiac death or myocardial infarction (MI) with angiotensin receptor blocker (ARB) compared with no renin angiotensin system (RAS) blockade in overall population and propensity matched populations
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Fig 4 Comparative unadjusted hazard ratios of cardiac death or myocardial infarction for subgroups in overall populations between angiotensin receptor blocker (ARB) and ACE inhibitor groups. LAD=left anterior descending artery
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Fig 5 Comparative unadjusted hazard ratios of cardiac death or myocardial infarction for subgroups in overall populations between angiotensin receptor blocker (ARB) and no renin angiotensin system (RAS) blockade groups. LAD=left anterior descending artery
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