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Impact of Angiotensin II Receptor Blockers on Clinical Outcomes after Percutaneous Coronary Intervention in Patients

Gwang Sil Kim1, Young Guk Ko2, Yongsung Suh3

  • 1Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Korean Circulation Journal
|July 30, 2020
PubMed

Insights

Angiotensin II receptor blockers (ARBs) show improved outcomes compared to angiotensin converting enzyme inhibitors (ACEIs) in acute myocardial infarction (AMI) patients post-percutaneous coronary intervention (PCI). ARB use was linked to a significantly lower risk of major adverse cardiovascular events (MACE).

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • The comparative effectiveness of Angiotensin II Receptor Blockers (ARBs) versus Angiotensin Converting Enzyme Inhibitors (ACEIs) in Acute Myocardial Infarction (AMI) patients remains unclear.
  • This study focuses on evaluating the impact of ARBs on clinical outcomes following Percutaneous Coronary Intervention (PCI) in AMI patients.

Purpose of the Study:

  • To compare the clinical outcomes of ARBs versus ACEIs in patients with AMI who have undergone PCI.
  • To assess the risk of major adverse cardiovascular events (MACE) associated with ARB use compared to ACEI use.

Main Methods:

  • A retrospective analysis of the Korean National Health Insurance Service database from January 2005 to December 2014.
  • Inclusion criteria: AMI patients treated with PCI and regularly taking either ACEIs (n=22,331) or ARBs (n=28,533).
  • Primary endpoint: Major Cardiovascular Adverse Event (MACE), defined as all-cause death, myocardial infarction (MI), or stroke. Propensity score-matching was employed.

Main Results:

  • The ARB group had a higher proportion of females, were older, and presented with more comorbidities than the ACEI group (p<0.001).
  • After propensity score-matching, ARB use was associated with a 23% lower risk of MACE compared to ACEI use (HR, 0.774; p<0.001).
  • Significantly reduced risks of all-cause death (HR, 0.741; p<0.001), MI (HR, 0.731; p<0.001), and revascularization (HR, 0.816; p<0.001) were observed with ARBs.

Conclusions:

  • In this retrospective study, ARB use demonstrated a lower risk of MACE, MI, and revascularization compared to ACEIs in AMI patients undergoing PCI.
  • The findings suggest ARBs may be a favorable therapeutic option for AMI patients post-PCI, particularly given their comparable or better outcomes in a sicker patient cohort.
Abstract

Keywords:
Angiotensin converting enzyme inhibitorsAngiotensin type II receptor blockersDrug therapyMyocardial infarction

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