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Comparison between angiotensin-converting enzyme inhibitor and angiotensin receptor blocker after percutaneous
Soe Hee Ann1, Martin H Strauss2, Gyung-Min Park1
1Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Republic of Korea.
Insights
Angiotensin-converting enzyme inhibitors (ACEI) significantly reduced mortality in acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI) compared to angiotensin receptor blockers (ARB). No significant difference was observed in angina patients.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Renin-angiotensin-aldosterone system (RAAS) inhibitors have varied mechanisms in coronary artery disease (CAD).
- Understanding the comparative effectiveness of ACEI and ARB in CAD patients undergoing PCI is crucial.
Purpose of the Study:
- To compare clinical outcomes between ACEI and ARB therapy in CAD patients post-PCI.
- To evaluate the impact of ACEI versus ARB on all-cause mortality in AMI and angina patients.
Main Methods:
- Retrospective analysis of South Korean National Health Insurance claims data (2011-2015).
- Inclusion of patients aged 18+ who underwent PCI, categorized into AMI (n=21,747) and angina (n=28,708) groups.
- Propensity-score matching analysis comparing ACEI and ARB post-PCI discharge medication groups, with all-cause death as the primary endpoint.
Main Results:
- Median follow-up was 2.2 years.
- In matched AMI patients (8341 pairs), ACEI significantly reduced all-cause death compared to ARB (HR 0.823, p=0.006).
- In matched angina patients (10,878 pairs), no significant difference in all-cause death was found between ACEI and ARB (HR 1.113, p=0.084).
Conclusions:
- ACEI therapy demonstrated a significant reduction in all-cause mortality for AMI patients undergoing PCI compared to ARB therapy.
- No significant difference in mortality was observed between ACEI and ARB in angina patients post-PCI.
Background:
The inhibitors for renin-angiotensin-aldosterone system (RAAS) have different mechanisms of action in coronary artery disease (CAD). This study sought to compare the clinical outcomes between angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) therapy in patients with CAD undergoing contemporary percutaneous coronary intervention (PCI).
Methods:
Based on the National Health Insurance claims data in South Korea, patients aged 18 years or older who had undergone PCI between July 2011 and June 2015 were enrolled. The study participants were classified either as patients with acute myocardial infarction (AMI, n = 21,747) or angina (n = 28,708). And according to the post PCI discharge medications, patients were categorized into ACEI and ARB therapy groups. The primary endpoint was all-cause death, and the two groups were compared using a propensity-score matching analysis.
Results:
The study population had a median follow-up of 2.2 years (interquartile range, 1.2-3.2). In the propensity-score matched AMI group (8341 pairs), the occurrence of all-cause death was significantly lower in the ACEI group than in the ARB group (hazard ratio [HR] of ACEI, 0.823; 95% confidence interval [CI]: 0.715-0.947; p = 0.006). In the propensity-score matched angina group (10,878 pairs), there was no difference in the incidence of the primary endpoint between the ACEI and ARB groups (HR of ACEI, 1.113; 95% CI: 0.986-1.257; p = 0.084).
Conclusions:
In this nationwide Korean cohort study, ACEI therapy in patients with AMI and concomitant PCI showed a significant reduction in all-cause mortality rates when compared to that with ARB therapy.
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