Department of Pharmacy, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, China.
Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
J Cardiovasc Pharmacol Ther. 2024 Jan-Dec;29:10742484241264673. doi: 10.1177/10742484241264673. Epub 2024 Jul 21.
This study evaluates the 3-year clinical outcomes of high Killip grade (III/IV) acute myocardial infarction (AMI) patients treated with either β-blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI) or BB and angiotensin receptor blockers (ARB).
A total of 13,105 patients were registered at the Korea Acute Myocardial Infarction Registry at the National Institute of Health (KAMIR-NIH). Among them, 871 patients with high Killip classification AMI were divided into the BB + ACEI group (n = 489) and the BB + ARB group (n = 381). Following propensity score matching, 343 patients were selected in each group. All patients completed a 3-year follow-up period.
The results indicate no significant differences between the BB + ACEI group and BB + ARB group in terms of cardiac death, recurrent myocardial infarction, and the rate of repeat percutaneous coronary intervention. However, the BB + ACEI group exhibited significantly lower risks in major adverse cardiac events (HR = 0.574, 95% CI: 0.421-0.783, < .001), all-cause mortality (HR = 0.561, 95% CI: 0.404-0.778, = .001), and non-cardiac death (HR = 0.365, 95% CI: 0.208-0.639, < .001) compared to the BB + ARB group.
Our results suggest that BB + ACEI treatment is more beneficial than BB + ARB for high Killip grade AMI patients. Additionally, the BB + ACEI group has a superior preventative effect on mortality compared to the BB + ARB group.
本研究评估了接受β受体阻滞剂（BB）和血管紧张素转换酶抑制剂（ACEI）或 BB 和血管紧张素受体阻滞剂（ARB）治疗的高 Killip 分级（III/IV）急性心肌梗死（AMI）患者的 3 年临床结局。
共 13105 例患者在韩国国立卫生研究院（KAMIR-NIH）的韩国急性心肌梗死注册中心登记。其中，871 例高 Killip 分级 AMI 患者分为 BB+ACEI 组（n=489）和 BB+ARB 组（n=381）。在倾向评分匹配后，每组各选择 343 例患者。所有患者均完成了 3 年随访。
BB+ACEI 组与 BB+ARB 组在心脏死亡、再发心肌梗死和再次经皮冠状动脉介入治疗率方面无显著差异。然而，BB+ACEI 组在主要不良心脏事件（HR=0.574，95%CI：0.421-0.783， < .001）、全因死亡率（HR=0.561，95%CI：0.404-0.778， = .001）和非心脏性死亡（HR=0.365，95%CI：0.208-0.639， < .001）方面的风险显著较低。
我们的结果表明，BB+ACEI 治疗对高 Killip 分级 AMI 患者比 BB+ARB 更有益。此外，与 BB+ARB 组相比，BB+ACEI 组在死亡率方面具有更好的预防效果。
