Abstract 10587: Lack Of Survival Benefit of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Revascularized Coronary Artery Disease Patients Without History of Myocardial Infarction
Background: There is a controversy if angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) provide a general cardiovascular protective effect in patients with coronary heart disease (CHD) but without heart failure or history of myocardial infarction (MI). This study aimed to investigate the association of ACEIs/ARBs and long-term outcomes in Japanese patients undergoing first percutaneous coronary intervention, with consideration of history of MI.
Methods: Patients undergoing first percutaneous coronary intervention during 2005-2007 were enrolled in CREDO-Kyoto registry cohort 2 at 26 hospitals. After excluding patients with malignant disease or in-hospital death, 11,590 patients were divided into 2 groups: the patients with MI (n=5,211) and those without MI (n=6,379). All-cause mortality was compared between the patients with and without ACEIs/ARBs at hospital discharge in each group.
Results: The median follow-up period was 2.6 years. In patients with MI, Kaplan-Meier analysis and log-rank test indicated significantly lower unadjusted all cause (at 3 years: 6.6% vs 11.7%; p<0.0001) as well as cardiovascular (at 3 years: 3.8% vs 6.9%; p<0.0001) mortality in patients with ACEIs/ARBs (n=3,812; 73.2%) compared to those without ACEIs/ARBs (n=1,399; 26.8%). After adjustment by multivariate analysis, ACEIs/ARBs therapy remained an independent predictor of lower all-cause mortality (relative risk=0.66, 95% confidence interval=0.52-0.85, p=0.0013). A trend toward lower all-cause mortality in patients with ACEIs/ARBs was consistently seen in acute MI or in old MI. However, in patients without MI, unadjusted as well as adjusted all-cause and cardiovascular mortalities were comparable between patients with and those without ACEIs/ARBs.
Conclusions: Use of ACEIs/ARBs was associated with lower mortality in revascularized CHD patients with MI: no survival benefit of ACEIs/ARBs was shown in patients without MI.
- © 2011 by American Heart Association, Inc.