Kim Yong Hoon, Her Ae-Young, Jeong Myung Ho, Kim Byeong-Keuk, Hong Sung-Jin, Kim Seunghwan, Ahn Chul-Min, Kim Jung-Sun, Ko Young-Guk, Choi Donghoon, Hong Myeong-Ki, Jang Yangsoo
Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine; Chuncheon-South Korea.
Department of Cardiology, Chonnam National University Hospital; Gwangju-South Korea.
Anatol J Cardiol. 2020 Jan;23(2):86-98. doi: 10.14744/AnatolJCardiol.2019.60374.
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.
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.
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), 1.154-4.495; 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, 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.
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.
目前，关于急性心肌梗死（AMI）合并血脂异常患者成功植入支架后，血管紧张素转换酶抑制剂（ACEIs）和血管紧张素II 1型（AT1）受体阻滞剂（ARBs）治疗后的长期主要临床结局的比较数据有限。因此，我们调查了这些患者接受ACEIs和ARBs治疗后2年的主要临床结局。
从韩国急性心肌梗死注册研究（KAMIR）中纳入了3015例成功植入支架并被处方ACEIs（n = 2175）或ARBs（n = 840）的AMI患者。主要临床终点是主要不良心脏事件（MACEs）的发生，定义为全因死亡、复发性心肌梗死（Re-MI）以及任何重复血运重建，包括靶病变血运重建（TLR）、靶血管血运重建（TVR）和非TVR。
调整后，ARBs组的全因死亡累积发生率显著高于ACEIs组[调整后风险比（aHR），2.277；95%置信区间（CI），1.154 - 4.495；p = 0.018]。两组之间MACEs（aHR，1.305；95%CI，0.911 - 1.869；p = 0.146）、心源性死亡、Re-MI、任何重复血运重建、TLR、TVR和非TVR的累积发生率相似。此外，高龄（≥65岁）、左心室射血分数降低（<50%）和入院时心肺复苏是本研究中全因死亡的有意义的独立预测因素。
对于成功植入支架的AMI合并血脂异常患者，在2年随访期间，与ARBs相比，ACEIs是降低全因死亡发生率的首选治疗方式。然而，需要进一步研究来确定这些结果的临床意义。
