title: Mortality benefit of long-term angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after successful percutaneous coronary intervention in non-ST elevation acute myocardial infarction.
abstract: OBJECTIVE
  Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to reduce mortality after myocardial infarction (MI). Current guidelines recommend their prescription in all patients after MI. Limited data are available on whether ACEIs/ARBs still improve prognosis in the contemporary era of non-ST elevation MI (NSTEMI) management. We aimed to evaluate the mortality benefit of ACEIs/ARBs in NSTEMI patients treated successfully with percutaneous coronary intervention (PCI).
  
  
  METHODS
  We analyzed 2784 patients with NSTEMI treated successfully with in-hospital PCI. Two groups were formed based on ACEI/ARB prescription at discharge. Two propensity score (PS) analyses were performed to control for differences in covariates: one with adjustment among the entire cohort, and the other with PS matching (n=1626). The outcome variable was all-cause mortality at four-year follow-up.
  
  
  RESULTS
  There were 1902 (68.3%) patients prescribed ACEIs/ARBs at discharge. When adjusted by PS, ACEI/ARB use was associated with a hazard ratio (HR) for mortality of 0.75 (0.60-0.94; absolute risk reduction [ARR] 4.0%) in the whole cohort (p=0.01). After one-to-one PS matching (n=813 in each group), the mortality rate was significantly lower in patients prescribed ACEIs/ARBs, with HR of 0.77 (0.63-0.94; ARR 3.8%) (p=0.03).
  
  
  CONCLUSIONS
  In this observational study of patients with NSTEMI, all of them treated successfully by PCI, the use of ACEIs/ARBs was significantly associated with a lower risk of four-year all-cause mortality.
authors.affiliation: Department of Cardiology and Coronary Care Unit, Complejo Hospitalario de Pontevedra, Pontevedra, Spain. Electronic address: cambe_cris@hotmail.com.
authors.forename: María Cristina
authors.initials: MC
authors.lastname: González-Cambeiro
authors.affiliation: Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: López-López
authors.affiliation: Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors.forename: Emad
authors.initials: E
authors.lastname: Abu-Assi
authors.affiliation: Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Raposeiras-Roubín
authors.affiliation: Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Peña-Gil
authors.affiliation: Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors.forename: José
authors.initials: J
authors.lastname: García-Acuña
authors.affiliation: Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: González-Juanatey
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Antagonistas do recetor da angiotensina; Enfarte do miocárdio sem elevação do segmento ST; Inibidores da enzima de conversão da angiotensina; Mortalidade; Mortality; Non-ST elevation myocardial infarction