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Effect of Angiotensin Receptor Blocker Dose in Myocardial Infarction With Preserved Left Ventricular Systolic
Hee-Yeol Kim1, Jisu Mok1,2, Jae-Young Kim3
1Department of Cardiology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea.
Insights
Higher doses of angiotensin receptor blockers (ARBs) did not improve outcomes for myocardial infarction (MI) patients with preserved left ventricular function. Dosing strategies did not significantly impact cardiac death or recurrent MI risk.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Myocardial infarction (MI) with preserved left ventricular (LV) systolic function is common.
- Optimal dosing of angiotensin receptor blockers (ARBs) in this patient population remains understudied.
- Previous research has not clearly defined the benefits of varying ARB doses post-MI with preserved LV function.
Purpose of the Study:
- To investigate the association between different doses of ARBs and clinical outcomes in patients following MI with preserved LV systolic function.
- To determine if higher ARB doses are associated with improved outcomes compared to lower doses or no ARB therapy.
- To evaluate the impact of ARB dosing on the composite endpoint of cardiac death or recurrent MI.
Main Methods:
- A multicenter registry of MI patients with preserved LV systolic function was utilized.
- Patients were grouped based on ARB dose indexed to target doses used in clinical trials: >0%-25%, >25%, and no ARB.
- Primary outcome was the composite of cardiac death or MI, analyzed using multivariable adjustment and propensity score analysis.
Main Results:
- Univariate analysis indicated lower mortality with any ARB use compared to no ARB.
- Multivariable and propensity score analyses showed no significant difference in cardiac death or MI risk between patients receiving >25% of target ARB dose versus those receiving ≤25% or no ARB.
- Hazard ratios for >25% target dose vs. ≤25% or no ARB were consistently around 1.0, indicating similar risk.
Conclusions:
- Treatment with >25% of target ARB dose does not confer better clinical outcomes than lower doses (≤25%) or no ARB in MI patients with preserved LV systolic function.
- Current ARB dosing strategies may not need adjustment for this specific patient group based on these findings.
- Further research may explore other therapeutic targets or individualized treatment approaches for MI patients with preserved LV function.
Abstract:
There have been few studies of angiotensin receptor blocker (ARB) dose in myocardial infarction (MI) with preserved left ventricular (LV) systolic function. We evaluated the association of ARB dose with clinical outcomes after MI with preserved LV systolic function. We used MI multicenter registry. Six months after discharge, the ARB dose was indexed to the target ARB doses used in randomized clinical trials and grouped as >0%-25% (n = 2333), >25% of the target dose (n = 1204), and no ARB (n = 1263). The primary outcome was the composite of cardiac death or MI. Univariate analysis showed that mortality of those with any ARB dose was lower than those without ARB therapy. After multivariable adjustment, patients receiving >25% of target dose had a similar risk of cardiac death or MI compared with those receiving ≤25% or no ARB [hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.83-1.33; HR 0.94, 95% CI 0.82-1.08, respectively]. Propensity score analysis also demonstrated that patients with >25% dose had no difference in primary endpoint compared with those ≤25% dose or the no ARB group (HR 1.03, 95% CI 0.79-1.33; HR 0.86, 95% CI 0.64-1.14, respectively). The present study demonstrates that patients treated with >25% of target ARB dose do not have better clinical outcomes than those treated with ≤25% of target ARB dose or those with no ARB dose in MI patients with preserved LV systolic function.
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