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Impact of Angiotensin II Receptor Blockers on Clinical Outcomes after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction Based on Data from the Korean National Health Insurance Database (2005?2014)

Korean Circulation Journal 2020년 50권 11호 p.984 ~ 994
김광실, 고영국, Suh Yong-Sung, 원호연, 홍성진, 안철민, 김정선, 김병극, 최동훈, 홍명기, 장양수,
소속 상세정보
김광실 ( Kim Gwang-Sil ) - Inje University College of Medicine Sanggye Paik Hospital Department of Internal Medicine
고영국 ( Ko Young-Guk ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
 ( Suh Yong-Sung ) - Myongji Hospital Department of Internal Medicine
원호연 ( Won Ho-Youn ) - Chung-Ang University College of Medicine Chung-Ang University Hospital Cardiovascular and Arrhythmia Center
홍성진 ( Hong Sung-Jin ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
안철민 ( Ahn Chul-Min ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
김정선 ( Kim Jung-Sun ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
김병극 ( Kim Byeong-Keuk ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
최동훈 ( Choi Dong-Hoon ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
홍명기 ( Hong Myeong-Ki ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
장양수 ( Jang Yang-Soo ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology

Abstract


Background and Objectives: The effectiveness of angiotensin II receptor blockers (ARBs) compared with angiotensin converting enzyme inhibitors (ACEIs) in patients with acute myocardial infarction (AMI) has not been established. We investigated the effects of ARBs on clinical outcomes after percutaneous coronary intervention (PCI) in AMI patients.

Methods: Patients receiving ACEIs or ARBs after AMI treated with PCI between January 2005 and December 2014 were selected from the Korean National Health Insurance Service database. The primary endpoint was major cardiovascular adverse event (MACE; all-cause death, myocardial infarct [MI], or stroke).

Results: We included patients regularly taking ACEIs (n=22,331) or ARBs (n=28,533) (medication possession ratio ≥80%). Compared with the ACEI group, the ARB group contained more females (31% vs. 18%), were older (mean, 63 vs. 60 years), and had more comorbidities, including hypertension (62.8% vs. 44.8%), diabetes (33.9% vs. 26.4%), congestive heart failure (7.9% vs. 4.3%), chronic obstructive pulmonary disease (25.5% vs. 18.9%), and end-stage renal disease (1.3% vs. 0.4%) (p<0.001 for all). After propensity score?matching, ARBs were associated with a 23% lower risk of MACE (hazard ratio [HR], 0.774; 95% confidence interval [CI], 0.715?0.838; p<0.001) than ACEIs. ARB use was also associated with a significantly reduced risk of death (HR, 0.741; 95% CI, 0.659?0.834; p<0.001), MI (HR, 0.731; 95% CI, 0.638?0.837; p<0.001), and revascularization (HR, 0.816; 95% CI, 0.773?0.861; p<0.001).

Conclusions: ARB use was associated with a lower risk of MACE, MI, and revascularization than ACEIs in our retrospective analysis of AMI patients who underwent PCI.

키워드

Angiotensin type II receptor blockers; Angiotensin converting enzyme inhibitors; Myocardial infarction; Drug therapy

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