Impact of renin angiotensin system inhibitor on 3-year clinical outcomes in acute myocardial infarction patients with preserved left ventricular systolic function: a prospective cohort study from Korea Acute Myocardial Infarction Registry (KAMIR)

Other KAMIR-NIH investigators

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Abstract

Background: 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. Method: 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. Results: 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). Conclusions: 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.

Original languageEnglish
Article number251
JournalBMC Cardiovascular Disorders
Volume21
Issue number1
DOIs
Publication statusPublished - 2021 Dec

Bibliographical note

Funding Information:
This study was done with the support of Korean Circulation Society (KCS) to commemorate the 50th Anniversary of KCS. The KAMIR study group of the KSC was as follows: Korea University Guro Hospital, Seoul, South Korea (Seung-Woon Rha), Gachon University Gil Medical Center, Incheon, South Korea (Tae Hoon Ahn), Wonju Severance Christian Hospital, Wonju, South Korea (Junghan Yoon), Seoul National University Hospital, Seoul, South Korea (Hyo-Soo Kim), Seoul St. Mary's Hospital, Seoul, South Korea (Ki-Bae Seung), Samsung Medical Center, Seoul, South Korea (Hyeon-Cheol Gwon), Kyungpook National University Hospital, Daegu, South Korea (Shung Chull Chae), Kyunghee University Hospital At Gangdong, Seoul, South Korea (Chong-Jin Kim), Pusan National University Hospital, Busan, South Korea (Kwang Soo Cha), Yeungnam University Medical Center, Daegu, South Korea (Jung-Hee Lee), Chonbuk National University Hospital, Jeongju, South Korea (Jei Keon Chae), Jeju National University Hospital, Jeju, South Korea (Seung-Jae Joo), Seoul National University Bundang Hospital, Bundang, South Korea (Chang-Hwan Yoon), Keimyung University Dongsan Medical Center, Daegu, South Korea (Seung-Ho Hur), Chungnam National University Hospital, Daejeon, South Korea (In-Whan Seong), Chungbuk National University Hospital, Cheongju, South Korea (Kyung-Kuk Hwang), Inje University Haeundae Paik Hospital, Busan, South Korea (Doo-Il Kim), Wonkwang University Hospital, Iksan, South Korea (Seok Kyu Oh), Gyeongsang National University Hospital, Jinju, South Korea (Jin-Yong Hwang), Chonnam National University Hospital, Gwangju, South Korea (Myung Ho Jeong).

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • AMI
  • Preserved LV systolic function
  • RAS inhibitor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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