title: Angiotensin II type 1 receptor blockers as a first choice in patients with acute myocardial infarction.
abstract: OBJECTIVE
  Angiotensin II type 1 receptor blockers (ARBs) have not been adequately evaluated in patients without left ventricular (LV) dysfunction or heart failure after acute myocardial infarction (AMI).
  
  
  METHODS
  Between November 2005 and January 2008, 6,781 patients who were not receiving angiotensin-converting enzyme inhibitors (ACEIs) or ARBs were selected from the Korean AMI Registry. The primary endpoints were 12-month major adverse cardiac events (MACEs) including death and recurrent AMI.
  
  
  RESULTS
  Seventy percent of the patients were Killip class 1 and had a LV ejection fraction ≥ 40%. The prescription rate of ARBs was 12.2%. For each patient, a propensity score, indicating the likelihood of using ARBs during hospitalization or at discharge, was calculated using a non-parsimonious multivariable logistic regression model, and was used to match the patients 1:4, yielding 715 ARB users versus 2,860 ACEI users. The effect of ARBs on in-hospital mortality and 12-month MACE occurrence was assessed using matched logistic and Cox regression models. Compared with ACEIs, ARBs significantly reduced in-hospital mortality(1.3% vs. 3.3%; hazard ratio [HR], 0.379; 95% confidence interval [CI], 0.190 to0.756; p = 0.006) and 12-month MACE occurrence (4.6% vs. 6.9%; HR, 0.661; 95% CI, 0.457 to 0.956; p = 0.028). However, the benefit of ARBs on 12-month mortality compared with ACEIs was marginal (4.3% vs. 6.2%; HR, 0.684; 95% CI, 0.467 to 1.002; p = 0.051).
  
  
  CONCLUSIONS
  Our results suggest that ARBs are not inferior to, and may actually be better than ACEIs in Korean patients with AMI.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jang Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Myung Hwan
authors.initials: MH
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Dong Heon
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Hun Sik
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Yongkeun
authors.initials: Y
authors.lastname: Cho
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Won Kee
authors.initials: WK
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea.
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center, Seoul, Korea.
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D056910:Republic of Korea; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin II type 1 receptor blockers; Angiotensin-converting enzyme inhibitors; Mortality; Myocardial infarction; Secondary prevention