title: Impact of ACE inhibitors on mortality and morbidity in patients with AMI: Does tissue selectivity matter?
abstract: OBJECTIVE
  To examine the impact of tissue selectivity of angiotensin-converting enzyme (ACE) inhibitors on mortality and morbidity in patients following acute myocardial infarction (AMI).
  
  
  METHODS
  A retrospective cohort study using a Medicaid claims database was conducted. Patients hospitalized for an AMI and subsequently filling a prescription for an ACE inhibitor were followed longitudinally for the occurrence of cardiovascular-related hospitalizations and all-cause mortality. A subanalysis was also conducted to account for switching/discontinuation of ACE inhibitor therapy. Stepwise (forward conditional) Cox-proportional hazards models were used to analyze the effect of tissue selectivity on study outcomes.
  
  
  RESULTS
  The final study sample consisted of 689 AMI and the results indicated that tissue-selective ACE inhibitors had a protective effect against hospitalization due to stroke/transient ischemic attack (TIA) (hazard ratio [HR] = 0.265; 95% confidence interval [CI] = 0.101-0.698). A similar lower rate in hospitalizations due to heart failure was observed in the group using tissue-selective ACE inhibitors; however, the results were not statistically significant (HR = 0.681; 95% CI = 0.436-1.063). A protective effect was also observed on the combined outcome of hospitalization due to any cardiovascular condition (HR = 0.712; 95% CI = 0.536-0.945). Hospitalizations due to recurrent AMI, need for coronary revascularization procedures, and mortality were not significantly different between patients using tissue-selective and non-tissue-selective ACE inhibitors. The completer subanalysis provided similar findings regarding the impact of tissue selectivity on study outcomes.
  
  
  CONCLUSIONS
  Tissue-selective ACE inhibitors may have a protective effect against hospitalization due to stroke/TIA or heart failure when compared to non-tissue-selective ACE inhibitors for patients following AMI.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, USA.
authors.forename: Iftekhar
authors.initials: I
authors.lastname: Kalsekar
authors.forename: Julie
authors.initials: J
authors.lastname: Koehler
authors.forename: John
authors.initials: J
authors.lastname: Mulvaney
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015897:Comorbidity; D004656:Enalapril / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D017706:Lisinopril / Q000494:pharmacology / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control* / Q000534:rehabilitation; D009928:Organ Specificity; D016016:Proportional Hazards Models; D017257:Ramipril / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D016019:Survival Analysis
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004656:Enalapril; D017706:Lisinopril; D017257:Ramipril