Cargando…
Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) are the first choice for the treatment of acute myocardial infarction (AMI), and angiotensin receptor blockers (ARBs) should be considered in patients intolerant to ACEIs. Although previous studies support the use of ARBs as an alternative...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Academy of Medical Sciences
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875434/ https://www.ncbi.nlm.nih.gov/pubmed/31760711 http://dx.doi.org/10.3346/jkms.2019.34.e289 |
_version_ | 1783473029880217600 |
---|---|
author | Lim, Sungmin Choo, Eun Ho Choi, Ik Jun Ihm, Sang-Hyun Kim, Hee-Yeol Ahn, Youngkeun Chang, Kiyuk Jeong, Myung Ho Seung, Ki-Bae |
author_facet | Lim, Sungmin Choo, Eun Ho Choi, Ik Jun Ihm, Sang-Hyun Kim, Hee-Yeol Ahn, Youngkeun Chang, Kiyuk Jeong, Myung Ho Seung, Ki-Bae |
author_sort | Lim, Sungmin |
collection | PubMed |
description | BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) are the first choice for the treatment of acute myocardial infarction (AMI), and angiotensin receptor blockers (ARBs) should be considered in patients intolerant to ACEIs. Although previous studies support the use of ARBs as an alternative to ACEIs, these studies showed inconsistent results. The objective of this study was to demonstrate the clinical impact of ARBs as an alternative to ACEIs in patients with AMI undergoing percutaneous coronary intervention (PCI). METHODS: The CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI (COREA-AMI) registry enrolled all consecutive patients with AMI undergoing PCI. The primary endpoint was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization due to heart failure. RESULTS: Of the 3,328 eligible patients, ARBs replaced ACEIs in 816 patients, while 824 patients continued to use ACEIs and 826 patients continued to use ARBs. The remaining 862 patients did not receive ACEIs/ARBs. After the adjustment with inverse probability weighting, the primary endpoints in the first groups were similar (7.5% vs. 8.0%, hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.75–1.05; P = 0.164). Composite events were less frequent in the ACEI to ARB group than no ACEI/ARB group (7.5% vs. 11.8%, HR, 0.76; 95% CI, 0.64–0.90; P = 0.002). CONCLUSION: The alternative use of ARBs following initial treatment with ACEIs demonstrates comparable clinical outcomes to those with continued use of ACEIs and is associated with an improved rate of composite events compared to no ACEI/ARB use in patients with AMI undergoing PCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02385682 |
format | Online Article Text |
id | pubmed-6875434 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | The Korean Academy of Medical Sciences |
record_format | MEDLINE/PubMed |
spelling | pubmed-68754342019-11-28 Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention Lim, Sungmin Choo, Eun Ho Choi, Ik Jun Ihm, Sang-Hyun Kim, Hee-Yeol Ahn, Youngkeun Chang, Kiyuk Jeong, Myung Ho Seung, Ki-Bae J Korean Med Sci Original Article BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) are the first choice for the treatment of acute myocardial infarction (AMI), and angiotensin receptor blockers (ARBs) should be considered in patients intolerant to ACEIs. Although previous studies support the use of ARBs as an alternative to ACEIs, these studies showed inconsistent results. The objective of this study was to demonstrate the clinical impact of ARBs as an alternative to ACEIs in patients with AMI undergoing percutaneous coronary intervention (PCI). METHODS: The CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI (COREA-AMI) registry enrolled all consecutive patients with AMI undergoing PCI. The primary endpoint was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization due to heart failure. RESULTS: Of the 3,328 eligible patients, ARBs replaced ACEIs in 816 patients, while 824 patients continued to use ACEIs and 826 patients continued to use ARBs. The remaining 862 patients did not receive ACEIs/ARBs. After the adjustment with inverse probability weighting, the primary endpoints in the first groups were similar (7.5% vs. 8.0%, hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.75–1.05; P = 0.164). Composite events were less frequent in the ACEI to ARB group than no ACEI/ARB group (7.5% vs. 11.8%, HR, 0.76; 95% CI, 0.64–0.90; P = 0.002). CONCLUSION: The alternative use of ARBs following initial treatment with ACEIs demonstrates comparable clinical outcomes to those with continued use of ACEIs and is associated with an improved rate of composite events compared to no ACEI/ARB use in patients with AMI undergoing PCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02385682 The Korean Academy of Medical Sciences 2019-10-24 /pmc/articles/PMC6875434/ /pubmed/31760711 http://dx.doi.org/10.3346/jkms.2019.34.e289 Text en © 2019 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Lim, Sungmin Choo, Eun Ho Choi, Ik Jun Ihm, Sang-Hyun Kim, Hee-Yeol Ahn, Youngkeun Chang, Kiyuk Jeong, Myung Ho Seung, Ki-Bae Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention |
title | Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention |
title_full | Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention |
title_fullStr | Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention |
title_full_unstemmed | Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention |
title_short | Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention |
title_sort | angiotensin receptor blockers as an alternative to angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction undergoing percutaneous coronary intervention |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875434/ https://www.ncbi.nlm.nih.gov/pubmed/31760711 http://dx.doi.org/10.3346/jkms.2019.34.e289 |
work_keys_str_mv | AT limsungmin angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention AT chooeunho angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention AT choiikjun angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention AT ihmsanghyun angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention AT kimheeyeol angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention AT ahnyoungkeun angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention AT changkiyuk angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention AT jeongmyungho angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention AT seungkibae angiotensinreceptorblockersasanalternativetoangiotensinconvertingenzymeinhibitorsinpatientswithacutemyocardialinfarctionundergoingpercutaneouscoronaryintervention |