• Jang Hoon Lee, Myung Hwan Bae, Dong Heon Yang, Hun Sik Park, Yongkeun Cho, Won Kee Lee, Myung Ho Jeong, Young Jo Kim, Myeong Chan Cho, Chong Jin Kim, Shung Chull Chae, and Korea Acute Myocardial Infarction Registry Investigators.
• Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
• Korean J. Intern. Med. 2016 Mar 1; 31 (2): 267-76.

Background/AimsAngiotensin 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).MethodsBetween 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.ResultsSeventy 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).ConclusionsOur results suggest that ARBs are not inferior to, and may actually be better than ACEIs in Korean patients with AMI.

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