Hae Chang Jeong1, Myung Ho Jeong2, Youngkeun Ahn2, Shung Chull Chae3, Seung Ho Hur4, Taek Jong Hong5, Young Jo Kim6, In Whan Seong7, Jei Keon Chae8, Jay Young Rhew9, In Ho Chae10, Myeong Chan Cho11, Jang Ho Bae12, Seung Woon Rha13, Chong Jin Kim14, Donghoon Choi15, Yang Soo Jang15, Junghan Yoon16, Wook Sung Chung17, Jeong Gwan Cho2, Ki Bae Seung17, Seung Jung Park18. 1. Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net. 2. Chonnam National University Hospital, Gwangju, Republic of Korea. 3. Kyungpuk National Univ. Hosp., Daegu, Republic of Korea. 4. Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 5. Busan National Univ. Hosp., Busan, Republic of Korea. 6. Yeungnam Univ. Hosp., Daegu, Republic of Korea. 7. Chungnam National Univ. Hosp., Daejon, Republic of Korea. 8. Chunbuk National Univ. Hosp., Jeonju, Republic of Korea. 9. Jeonju Presbyterian Medical Center, Jeonju, Republic of Korea. 10. Seoul National University Bundang Hospital, Republic of South Korea. 11. Chungbuk National University Hospital, Cheongju, Republic of Korea. 12. Konyang University, Daejon, Republic of Korea. 13. Korea University Guro Hospital, Seoul, Republic of Korea. 14. Kyung Hee Univ. Hosp., Seoul, Republic of Korea. 15. Yonsei University Hospital, Seoul, Republic of Korea. 16. Wonju University Hospital, Wonju, Republic of Korea. 17. Catholic University Hospital, Seoul, Republic of Korea. 18. Asan Medical Center, Seoul, Republic of Korea.
Abstract
BACKGROUND: The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). METHODS: We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. RESULTS: In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p=0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p=0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p=0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. CONCLUSIONS: In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.
BACKGROUND: The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). METHODS: We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. RESULTS: In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p=0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p=0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p=0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. CONCLUSIONS: In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.
Authors: Hyun Kuk Kim; Myung Ho Jeong; Seung Hun Lee; Doo Sun Sim; Young Joon Hong; Youngkeun Ahn; Chong Jin Kim; Myeong Chan Cho; Young Jo Kim Journal: Korean J Intern Med Date: 2014-10-31 Impact factor: 2.884
Authors: Jumin Won; Young Joon Hong; Myung Ho Jeong; Hyuk Jin Park; Min Chul Kim; Woo Jin Kim; Hyun Kuk Kim; Doo Sun Sim; Ju Han Kim; Youngkeun Ahn; Jeong Gwan Cho; Jong Chun Park Journal: Chonnam Med J Date: 2016-05-20