title: Effect of renin-angiotensin system inhibitors on long-term survival in patients treated with beta blockers and antiplatelet agents after acute myocardial infarction (from the MONICA/KORA Myocardial Infarction Registry).
abstract: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have shown to decrease mortality and cardiovascular morbidity especially in high-risk patients after acute myocardial infarction (AMI). Aim of this study was to assess the association between ACEI or ARB treatment (ACEI/ARB) at hospital discharge and long-term survival after AMI in real-life patient care. From a German population-based AMI registry, 3,544 patients (75.4% men), aged 28 to 74 years, hospitalized with an incident AMI between 2000 and 2008, surviving at least 24 hours and treated with β blockers and antiplatelet agents at discharge were included in this study. All data were collected by standardized interviews and chart review. End point of this study was all-cause mortality at 3 follow-up periods: 1, 3, and 5 years after AMI. Mortality was assessed for all registered patients in 2010. Survival analyses and multivariable Cox regression analyses were conducted. Of the 3,544 patients, 83.7% received ACEI/ARB and 90.1% were treated with statins at hospital discharge. During a median follow-up period of 5.0 years (interquartile range 1.0 years), 9.3% patients died. In the multivariable Cox models adjusting for a number of covariates, use of ACEI/ARB showed a significantly inverse relation with 1-, 3-, and 5-year mortality (e.g., 5-year mortality: hazard ratio 0.74, 95% confidence interval 0.59 to 0.94, p = 0.015), and the hazard ratios for mortality did not differ significantly between the 3 examined follow-up periods. In conclusion, use of ACEI/ARB at hospital discharge is independently associated with long-term survival benefit in patients with incident AMI already treated with other guideline-recommended cardiovascular drugs.
authors.affiliation: MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; Institute of Epidemiology II, German Research Center for Environmental Health (GmbH), Helmholtz Zentrum München, Neuherberg, Germany. Electronic address: ute.amann@helmholtz-muenchen.de.
authors.forename: Ute
authors.initials: U
authors.lastname: Amann
authors.affiliation: MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; Institute of Epidemiology II, German Research Center for Environmental Health (GmbH), Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Inge
authors.initials: I
authors.lastname: Kirchberger
authors.affiliation: MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; Institute of Epidemiology II, German Research Center for Environmental Health (GmbH), Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Heier
authors.affiliation: Institute of Epidemiology II, German Research Center for Environmental Health (GmbH), Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Zirngibl
authors.affiliation: Department of Internal Medicine I-Cardiology, Central Hospital of Augsburg, Augsburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: von Scheidt
authors.affiliation: Department of Internal Medicine I-Cardiology, Central Hospital of Augsburg, Augsburg, Germany; Department of Internal Medicine-Cardiology, Hospital of Nördlingen, Nördlingen, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kuch
authors.affiliation: Institute of Epidemiology II, German Research Center for Environmental Health (GmbH), Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
authors.affiliation: MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; Institute of Epidemiology II, German Research Center for Environmental Health (GmbH), Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012042:Registries; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors