Chonnam National University Hospital, Gwangju, Republic of Korea.
Chonnam National University Hospital, Gwangju, Republic of Korea.
Int J Cardiol. 2014 Jan 1;170(3):291-7. doi: 10.1016/j.ijcard.2013.07.146. Epub 2013 Nov 13.
The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI).
We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery.
In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p=0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p=0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p=0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function.
In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.
血管紧张素 II 型 1 型受体阻滞剂（ARB）的拮抗机制不同：不可逾越的拮抗作用和可逾越的拮抗作用。最近的回顾性观察研究表明，ARB 在各种临床情况下可能没有等效的益处。本研究旨在比较两种 ARB 类别对急性心肌梗死（AMI）患者长期临床结局的影响。
我们分析了大规模、前瞻性、观察性的韩国急性心肌梗死登记研究，该研究纳入了 2740 例 AMI 患者。根据出院时可逾越的 ARB 或不可逾越的 ARB 的处方将患者分为两组。主要终点是主要不良心脏事件（MACEs），定义为心脏死亡、非致死性心肌梗死和再次经皮冠状动脉介入治疗、冠状动脉旁路移植术的复合事件。
在总体人群中，可逾越 ARB 组 1 年时的 MACEs 发生率显著较高（14.3%比 11.2%，p=0.025），这主要是由于心脏死亡增加（3.3%比 1.9%，p=0.031）。通过倾向评分匹配得到了一致的结果（MACEs 发生率：14.9%比 11.4%，p=0.037）。亚组分析显示，不可逾越的 ARB 治疗可显著降低左心室射血分数大于 40%、Killip 分级低、ST 段抬高型心肌梗死和肾功能正常的患者的 MACEs 发生率。
在我们的研究中，不可逾越的 ARB 在 AMI 患者中的长期临床结局优于可逾越的 ARB。
