Comparative assessment of angiotensin II type 1 receptor blockers in the treatment of acute myocardial infarction: surmountable vs. insurmountable antagonist.
BACKGROUND
The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI).


METHODS
We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery.


RESULTS
In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p=0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p=0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p=0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function.


CONCLUSIONS
In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.
Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
Hae Chang
HC
Jeong
Chonnam National University Hospital, Gwangju, Republic of Korea.
Myung Ho
MH
Jeong
Chonnam National University Hospital, Gwangju, Republic of Korea.
Youngkeun
Y
Ahn
Kyungpuk National Univ. Hosp., Daegu, Republic of Korea.
Shung Chull
SC
Chae
Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
Seung Ho
SH
Hur
Busan National Univ. Hosp., Busan, Republic of Korea.
Taek Jong
TJ
Hong
Yeungnam Univ. Hosp., Daegu, Republic of Korea.
Young Jo
YJ
Kim
Chungnam National Univ. Hosp., Daejon, Republic of Korea.
In Whan
IW
Seong
Chunbuk National Univ. Hosp., Jeonju, Republic of Korea.
Jei Keon
JK
Chae
Jeonju Presbyterian Medical Center, Jeonju, Republic of Korea.
Jay Young
JY
Rhew
Seoul National University Bundang Hospital, Republic of South Korea.
In Ho
IH
Chae
Chungbuk National University Hospital, Cheongju, Republic of Korea.
Myeong Chan
MC
Cho
Konyang University, Daejon, Republic of Korea.
Jang Ho
JH
Bae
Korea University Guro Hospital, Seoul, Republic of Korea.
Seung Woon
SW
Rha
Kyung Hee Univ. Hosp., Seoul, Republic of Korea.
Chong Jin
CJ
Kim
Yonsei University Hospital, Seoul, Republic of Korea.
Donghoon
D
Choi
Yonsei University Hospital, Seoul, Republic of Korea.
Yang Soo
YS
Jang
Wonju University Hospital, Wonju, Republic of Korea.
Junghan
J
Yoon
Catholic University Hospital, Seoul, Republic of Korea.
Wook Sung
WS
Chung
Chonnam National University Hospital, Gwangju, Republic of Korea.
Jeong Gwan
JG
Cho
Catholic University Hospital, Seoul, Republic of Korea.
Ki Bae
KB
Seung
Asan Medical Center, Seoul, Republic of Korea.
Seung Jung
SJ
Park
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000401:mortality; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers
Angiotensin; Myocardial infarction; Prognosis