Comparison of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with diabetes mellitus and non-ST-segment elevation myocardial infarction who underwent successful percutaneous coronary intervention

Background and aims: Angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are known to be beneficial for either non-ST-segment elevation myocardial infarction (NSTEMI) patients or diabetes mellitus (DM) patients. However, the comparative efficacy of ACEI versus ARB in patients with NSTEMI and DM is unclear. The aim of this study was to compare the protective efficacy of ACEI versus ARB in patients with NSTEMI and DM, who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Methods: Among 53,281 patients enrolled in the nationwide Korea Acute Myocardial Infarction Registry, 3426 patients with NSTEMI and DM, who were treated with renin-angiotensin system (RAS) inhibitors, had undergone successful PCI with DESs. They were classified into two groups: ACEI group (N = 2076), and ARB group (N = 1350). Individual major clinical outcomes and major adverse cardiac events (MACE), the composite of total death, myocardial infarction (MI), and revascularization were compared between the two groups for up to two years. Results: After propensity score-matching analysis, two propensity-matched groups (1103 pairs, total = 2206) were generated, and the baseline characteristics were balanced. Although all causes of death and recurrent MI were not different between the two groups, the incidence of revascularization (4.0% vs. 7.1%; p = 0.002), including target vessel (2.3% vs. 5.0; p = 0.002), and MACE (8.7% vs. 12.5%, p = 0.008), were lower in the ACEI group than the ARB group at two-year follow-up. Conclusions: Compared with ARB, no beneficial effects of ACEI on all causes of death, cardiac death, or recurrence of MI were observed, but ACEI reduced the incidence of revascularization and MACE in this population. Thus, well-designed trials with a larger population are needed to confirm these results.