Long-term use of renin-angiotensin-system inhibitors after acute myocardial infarction is not associated with survival benefits: Analysis of data from the Korean acute myocardial infarction registry-national institutes of health registry

the KAMIR-NIH Registry

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Renin-angiotensin-system inhibitors (RASi) have shown survival benefits after acute myocardial infarction (MI), but the role of routine long-term use of RASi remains unclear. Thereby, we explored the therapeutic effects of RASi medication at 1-year follow-up from acute MI. Methods: Using the nationwide Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) registry, we included and analyzed 10,822 subjects. Patients were stratified into those taking RASi at 1-year follow-up (n = 7,696) and those not taking RASi at 1-year follow-up (n = 3,126). Patients were followed up for 2-years from the 1-year follow-up; 2-year all-cause mortality and cardiac mortality were analyzed as primary and secondary outcomes, respectively. Results: The use of RASi at 1-year follow-up was not associated with decreased all-cause mortality (log-rank P = 0.195) or cardiac mortality (log-rank P = 0.337). In multivariate analyses, RASi medication at 1-year follow-up did not reduce all-cause mortality (P = 0.758) or cardiac mortality (P = 0.923), while RASi medication at discharge substantially reduced 1-year all-cause and cardiac mortality. Treatment with either an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker at 1-year follow-up did not show survival benefits from 1-year follow-up, respectively. The use of RASi at 1-year follow-up did not show a prognostic interaction between previous history of chronic kidney disease, post-MI acute heart failure, concomitant use of beta-blockers at 1-year follow-up, or 1-year LVEF. Conclusion: Acute MI patients taking RASi at 1-year follow-up were not associated with improved 2-year all-cause mortality or cardiac mortality from the 1-year follow-up. This study provides valuable information regarding tailored medication strategy after acute MI. Clinical trial registration: [www.ClinicalTrials.gov], identifier [KCT0000863].

Original languageEnglish
Article number994419
JournalFrontiers in Cardiovascular Medicine
Volume9
DOIs
Publication statusPublished - 2022 Aug 31
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the Korea Health Technology R&D Project “Korea Research-Driven Hospital (grant no. HI14C1277),” “The Strategic Center of Cell and Bio Therapy (grant no. HI17C2085)” through the Korea Health Industry Development Institute (KHIDI), and “The National Research Foundation of Korea (NRF)” (grant no. 2020R1A2C1011311) funded by the Korea Government.

Publisher Copyright:
Copyright © 2022 Park, Yang, Kang, Han, Park, Kang, Koo, Seung, Cha, Seong, Rha, Jeong and Kim.

Keywords

  • acute myocardial infarction
  • angiotensin II receptor blocker
  • angiotensin converting enzyme inhibitor
  • mortality
  • prognosis
  • renin-angiotensin-system inhibitor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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