Abstract 12931: Comparative Effectiveness of Different Angiotensin II-Receptor Blockers for Survivors of ST-Elevation Myocardial Infarction: A Nationwide Cohort Study Using Insurance Claims Database
Introduction: The use of angiotensin II-receptor blockers (ARBs) is a practical alternative to angiotensin-converting enzymes inhibitor in patients after ST elevation myocardial infarction (STEMI).
Hypothesis: There is no study to compare the effect of different kinds of ARBs. The aim of this study was to determine the impact of different ARBs on cardiovascular outcomes in patients after first STEMI.
Methods: Patients who were discharged with first STEMI between January 1, 2003 and December 31, 2010 were identified from the National Health Insurance Research Database, Taiwan. We compared patients prescribed with losartan, valsartan, irbesartan, or candesartan within 30 days after discharge from the index hospitalization. The study end-points were all-cause death, cardiovascular death and recurrent myocardial infarction. The propensity score was constructed using logistic regression to model receipt of different ARBs as a function of the baseline patient characteristics. Treating the losartan group as the common reference, pairwise contrast approach using Cox regression model with adjustment for age, sex and the propensity score was used to compare the relative risks of different outcomes among the four different ARBs.
Results: A total of 8036 patients were enrolled during approximately 0.94 years of follow-up (n=2061 for losartan, n=3806 for valsartan, n=1024 for irbesartan, n=1145 for candesartan). We found no difference between risks of all-cause death and recurrent myocardial infarction among the four ARB groups. However, patients in the irbesartan group had a higher risk of cardiovascular death compared with the losartan group (adjust hazard ratio [HR]: 1.60, 95% confidence interval [CI]: 1.00-2.57, p=0.051 in pairwise contrast approach; adjust HR: 1.62, 95% CI: 1.01-2.58, p=0.044 in simultaneous four-group comparison approach). In subgroup analysis, the increased risk of cardiovascular death in irbesartan group was more prominent in patients aged over 65 years (adjusted HR: 1.82, 95% CI: 1.09-3.05, p=0.022).
Conclusions: Treatment with irbesartan in patients after first STEMI was associated with increased risk of cardiovascular death compared with losartan, valsartan and candesartan, especially in patients over 65 years old.
Author Disclosures: M. Liao: None. C. Lai: None. Y. Lee: None. K. Chan: None. H. Chen: None. M. Lai: None.
- © 2014 by American Heart Association, Inc.