Comparison between angiotensin-converting enzyme inhibitor and angiotensin receptor blocker after percutaneous coronary intervention. (1st May 2020)

• Record Type: Journal Article
• Authors: Ann, Soe Hee; Strauss, Martin H.; Park, Gyung-Min; Han, Seungbong; Yang, Yujin; Kim, Yong-Giun; Won, Ki-Bum; Kim, Shin-Jae; Lee, Sang-Gon; Cho, Young-Rak; Kim, Dae-Won; Park, Mahn-Won; Her, Sung Ho; Lee, Seung-Whan
• Is Part Of: International journal of cardiology. Volume 306(2020)
• Page Start: 35
• Page End: 41
• Publication Date: 2020-05-01
• Subjects: ACEI angiotensin-converting enzyme inhibitors -- AMI acute myocardial infarction -- ARB angiotensin receptor blockers -- CABG coronary artery bypass surgery -- CAD coronary artery disease -- HIRA Health Insurance Review & Assessment Service -- HR Hazard ratio -- ICD-10 International Classification of Diseases, 10th Revision -- KAMIR Korea Acute Myocardial Infarction Registry -- MI myocardial infarction -- NHI National Health Insurance -- PCI percutaneous coronary intervention -- RAAS renin-angiotensin-aldosterone system; Angiotensin-converting enzyme inhibitors -- Angiotensin receptor blockers -- Acute myocardial infarction -- Coronary artery disease -- Percutaneous coronary intervention; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.11.086
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The inhibitors for renin-angiotensin-aldosterone system (RAAS) have different mechanisms of action in coronary artery disease (CAD). This study sought to compare the clinical outcomes between angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) therapy in patients with CAD undergoing contemporary percutaneous coronary intervention (PCI). Methods: Based on the National Health Insurance claims data in South Korea, patients aged 18 years or older who had undergone PCI between July 2011 and June 2015 were enrolled. The study participants were classified either as patients with acute myocardial infarction (AMI, n = 21, 747) or angina ( n = 28, 708). And according to the post PCI discharge medications, patients were categorized into ACEI and ARB therapy groups. The primary endpoint was all-cause death, and the two groups were compared using a propensity-score matching analysis. Results: The study population had a median follow-up of 2.2 years (interquartile range, 1.2–3.2). In the propensity-score matched AMI group (8341 pairs), the occurrence of all-cause death was significantly lower in the ACEI group than in the ARB group (hazard ratio [HR] of ACEI, 0.823; 95% confidence interval [CI]: 0.715–0.947; p = 0.006). In the propensity-score matched angina group (10, 878 pairs), there was no difference in the incidence of the primary endpoint between the ACEI and ARB groups (HR of ACEI, 1.113; 95% CI: 0.986–1.257; p = 0.084). Conclusions: In this nationwide Korean cohort study, ACEI therapy in patients with AMI and concomitant PCI showed a significant reduction in all-cause mortality rates when compared to that with ARB therapy. Highlights: Blockade of renin-angiotensin-aldosterone system is important in coronary disease. Angiotensin-converting enzyme inhibitors are recommended as a first line therapy. Angiotensin receptor blockers are recommended as a second line, for intolerance. First line therapy showed lower mortality rates in acute myocardial infarction.