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Long-term use of renin-angiotensin-system inhibitors after acute myocardial infarction is not associated with survival benefits: Analysis of data from the Korean acute myocardial infarction registry-national institutes of health registry.
Park, Chan Soon; Yang, Han-Mo; Kang, Jeehoon; Han, Jung-Kyu; Park, Kyung Woo; Kang, Hyun-Jae; Koo, Bon-Kwon; Seung, Ki-Bae; Cha, Kwang Soo; Seong, In-Whan; Rha, Seung-Woon; Jeong, Myung Ho; Kim, Hyo-Soo.
Affiliation
  • Park CS; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
  • Yang HM; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
  • Kang J; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
  • Han JK; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
  • Park KW; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
  • Kang HJ; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
  • Koo BK; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
  • Seung KB; Cardiology Division, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
  • Cha KS; Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea.
  • Seong IW; Department of Internal Medicine, College of Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, South Korea.
  • Rha SW; Department of Internal Medicine, College of Medicine, Kyungpook National University, Daegu, South Korea.
  • Jeong MH; Department of Internal Medicine and Heart Center, Chonnam National University Hospital, Gwangju, South Korea.
  • Kim HS; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Front Cardiovasc Med ; 9: 994419, 2022.
Article in En | MEDLINE | ID: mdl-36119742
ABSTRACT

Introduction:

Renin-angiotensin-system inhibitors (RASi) have shown survival benefits after acute myocardial infarction (MI), but the role of routine long-term use of RASi remains unclear. Thereby, we explored the therapeutic effects of RASi medication at 1-year follow-up from acute MI.

Methods:

Using the nationwide Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) registry, we included and analyzed 10,822 subjects. Patients were stratified into those taking RASi at 1-year follow-up (n = 7,696) and those not taking RASi at 1-year follow-up (n = 3,126). Patients were followed up for 2-years from the 1-year follow-up; 2-year all-cause mortality and cardiac mortality were analyzed as primary and secondary outcomes, respectively.

Results:

The use of RASi at 1-year follow-up was not associated with decreased all-cause mortality (log-rank P = 0.195) or cardiac mortality (log-rank P = 0.337). In multivariate analyses, RASi medication at 1-year follow-up did not reduce all-cause mortality (P = 0.758) or cardiac mortality (P = 0.923), while RASi medication at discharge substantially reduced 1-year all-cause and cardiac mortality. Treatment with either an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker at 1-year follow-up did not show survival benefits from 1-year follow-up, respectively. The use of RASi at 1-year follow-up did not show a prognostic interaction between previous history of chronic kidney disease, post-MI acute heart failure, concomitant use of beta-blockers at 1-year follow-up, or 1-year LVEF.

Conclusion:

Acute MI patients taking RASi at 1-year follow-up were not associated with improved 2-year all-cause mortality or cardiac mortality from the 1-year follow-up. This study provides valuable information regarding tailored medication strategy after acute MI. Clinical trial registration [www.ClinicalTrials.gov], identifier [KCT0000863].
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prognostic_studies / Risk_factors_studies Language: En Journal: Front Cardiovasc Med Year: 2022 Document type: Article Affiliation country: Corea del Sur

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prognostic_studies / Risk_factors_studies Language: En Journal: Front Cardiovasc Med Year: 2022 Document type: Article Affiliation country: Corea del Sur