Comparison between angiotensin-converting enzyme inhibitor and angiotensin receptor blocker after percutaneous coronary intervention

Soe Hee Ann, Martin H. Strauss, Gyung Min Park, Seungbong Han, Yujin Yang, Yong Giun Kim, Ki Bum Won, Shin Jae Kim, Sang Gon Lee, Young Rak Cho, Dae Won Kim, Mahn Won Park, Sung Ho Her, Seung Whan Lee

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13 Scopus citations

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.

Original languageEnglish
Pages (from-to)35-41
Number of pages7
JournalInternational Journal of Cardiology
Volume306
DOIs
StatePublished - 1 May 2020

Bibliographical note

Funding Information:
This research was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education ( 2018R1D1A3B07043344 ) and the Ministry of Science, ICT & Future Planning ( 2017R1C1B1006717 ).

Publisher Copyright:
© 2019 Elsevier B.V.

Keywords

  • Acute myocardial infarction
  • Angiotensin receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Coronary artery disease
  • Percutaneous coronary intervention

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