Cardiovascular Center, Incheon Sejong Hospital, Incheon, South Korea.
Cardiovascular Research Institute, University, Seoul, South Korea.
BMC Cardiovasc Disord. 2021 May 21;21(1):251. doi: 10.1186/s12872-021-02070-x.
Patients with acute myocardial infarction (AMI) are usually treated with angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) if ACEIs are not tolerated. However, there is no data regarding the impact of switching from ACEIs to ARBs on long-term clinical outcomes in AMI patients with preserved left ventricular (LV) systolic function especially beyond 1 year. To investigate the effectiveness of treatment with ACEIs or ARBs on clinical outcomes over 3 years in AMI patients with preserved LV systolic function following percutaneous coronary intervention.
It is a prospective cohort study using data from a nationwide large scale registry with 53 hospitals involved in treatment of acute myocardial infarction (AMI) in Korea. Between March 2011 and September 2015, we enrolled 6236 patients with AMI who underwent primary percutaneous coronary intervention and had a left ventricular ejection fraction ≥ 50%. Main outcome measures composite of total death or recurrent AMI over 3 years after AMI. Patients were divided into an ACEI group (n = 2945), ARB group (n = 2197), or no renin-angiotensin system inhibitor (RASI) treatment (n = 1094). We analyzed patients who changed treatment. Inverse probability of treatment weighting (IPTW) analysis was also performed.
After the adjustment with inverse probability weighting, the primary endpoints at 1 year, AMI patients receiving ACEIs showed overall better outcomes than ARBs [ARBs hazard ratio (HR) compared with ACEIs 1.384, 95% confidence interval (CI) 1.15-1.71; P = 0.003]. However, 33% of patients receiving ACEIs switched to ARBs during the first year, while only about 1.5% switched from ARBs to ACEIs. When landmark analysis was performed from 1 year to the end of the study, RASI group showed a 31% adjusted reduction in primary endpoint compared to patients with no RASI group (HR, 0.74; 95% CI 0.56-0.97; P = 0.012).
This result suggests that certain patients got benefit from treatment with ACEIs in the first year if tolerated, but switching to ARBs beyond the first year produced similar outcomes. RASI beyond the first year reduced death or recurrent AMI in AMI patients with preserved LV systolic function. CRIS Registration number: KCT0004990.
急性心肌梗死（AMI）患者通常接受血管紧张素转换酶抑制剂（ACEI）治疗，如果不能耐受 ACEI，则使用血管紧张素受体阻滞剂（ARB）。然而，对于左心室射血分数（LV）收缩功能保留的 AMI 患者，从 ACEI 转换为 ARB 对长期临床结局的影响，特别是在 1 年以上，目前尚无相关数据。本研究旨在探讨经皮冠状动脉介入治疗后左心室收缩功能保留的 AMI 患者，使用 ACEI 或 ARB 治疗 3 年以上的临床结局。
这是一项前瞻性队列研究，使用韩国全国范围内 53 家参与治疗急性心肌梗死（AMI）的医院的数据。研究纳入 2011 年 3 月至 2015 年 9 月接受经皮冠状动脉介入治疗且左心室射血分数≥50%的 6236 例 AMI 患者。主要终点是 AMI 后 3 年总死亡率或复发性 AMI 的复合终点。患者被分为 ACEI 组（n=2945）、ARB 组（n=2197）或未使用肾素-血管紧张素系统抑制剂（RASI）组（n=1094）。我们分析了接受药物转换的患者。还进行了逆概率加权（IPTW）分析。
经过 IPTW 调整后，1 年时 ACEI 组的主要终点优于 ARB 组[ARB 组与 ACEI 组的 HR 为 1.384，95%置信区间（CI）为 1.15-1.71；P=0.003]。然而，33%接受 ACEI 治疗的患者在第 1 年内转为 ARB 治疗，而只有约 1.5%的患者从 ARB 转为 ACEI 治疗。从第 1 年到研究结束进行的 landmark 分析显示，RASI 组的主要终点较无 RASI 组降低 31%（HR，0.74；95%CI，0.56-0.97；P=0.012）。
如果能耐受的话，某些患者在第 1 年使用 ACEI 治疗可获益，但在第 1 年后转换为 ARB 治疗可产生相似的结局。第 1 年以后使用 RASI 可降低左心室收缩功能保留的 AMI 患者的死亡或复发性 AMI 风险。CRIS 注册号：KCT0004990。
