Soe Hee Ann1, Martin H Strauss2, Gyung-Min Park3, Seungbong Han4, Yujin Yang1, Yong-Giun Kim1, Ki-Bum Won1, Shin-Jae Kim1, Sang-Gon Lee1, Young-Rak Cho5, Dae-Won Kim6, Mahn-Won Park6, Sung Ho Her6, Seung-Whan Lee7. 1. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Republic of Korea. 2. Department of Cardiology, North York General Hospital, University of Toronto, Canada. 3. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Republic of Korea. Electronic address: min8684@hanmail.net. 4. Department of Applied Statistics, Gachon University, Seongnam, Republic of Korea. Electronic address: hanseungbong@gmail.com. 5. Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea. 6. Department of Cardiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea. 7. Departments of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
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.
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.
Authors: Gwang Sil Kim; Young Guk Ko; Yongsung Suh; Hoyoun Won; Sung Jin Hong; Chul Min Ahn; Jung Sun Kim; Byeong Keuk Kim; Donghoon Choi; Myeong Ki Hong; Yangsoo Jang Journal: Korean Circ J Date: 2020-07-13 Impact factor: 3.243