Abstract 9432: Superior Long-term Prognostic Impact of Angiotensin Converting Enzyme Inhibitors to Angiotensin II Receptor Blockers After ST-Elevation Myocardial Infarction
Background: Although international guidelines recommend angiotensin-converting enzyme inhibitor (ACEI) as the first-line therapy after ST-elevation myocardial infarction (STEMI), the prescription of angiotensin II receptor blockers (ARB) is surpassing that of ACEI worldwide. Here, we examined whether the long-term benefits of ARB are comparable with those of ACEI in post-STEMI patients in the real-world setting.
Methods: We compared 5-year survival benefits of ACEI and ARB in 7,547 consecutive STEMI patients registered with the Osaka Acute Coronary Insufficiency study between 1998 and 2010. Study subjects were divided into 3 groups: patients treated with ACEI (n=3,794), ARB (n=1,786), or without either drug (n=1,967) at survival discharge.
Results: A total of 545 deaths were recorded during a median follow-up period of 3.9 years after survival discharge. The prescription rate of ARB at discharge increased from 1998 to 2010, whereas that of ACEI decreased (p<0.001). Cox regression analysis revealed that treatment with either ACEI or ARB at discharge was associated with reduced 5-year mortality (adjusted hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.56-0.81, p<0.001; and HR 0.76, 95% CI 0.60-0.96, p=0.021, respectively). However, Kaplan-Meier estimates and Cox regression analyses based on propensity score (PS) revealed that ACEI was associated with significantly better survival than ARB from 2 to 5 years after survival discharge (adjusted HR 0.57, 95% CI 0.40-0.81, p=0.002) despite comparable prognostic impacts for the first 2 years (adjusted HR 1.03, 95% CI 0.71-1.49, p=0.878). These findings were also confirmed in a PS-matched population.
Conclusions: Although ACEI and ARB treatment showed comparable prognostic impacts in the first 2 years after STEMI onset, treatment with ACEI was associated with better survival from 2 to 5 years. Further investigations are warranted to confirm the results.
- © 2013 by American Heart Association, Inc.