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Comparative effect of angiotensin converting enzyme inhibitor versus angiotensin ii type i receptor blocker in acute myocardial infarction with non-obstructive coronary arteries; from the Korea Acute Myocardial Infarction Registry — National Institute of Health

Joon Ho Ahn, Ju Yong Hyun, Myung Ho Jeong, Ju Han Kim, Young Joon Hong, Doo Sun Sim, Min Chul Kim, Hun-Sik Park, Doo-Il Kim, Seung-Ho Hur, Seok Kyu Oh, Youngkeun Ahn
DOI: 10.5603/CJ.a2020.0130
·
Pubmed: 33001422

open access

Ahead of print
Original articles
Published online: 2020-09-28

Abstract

Background: Selecting angiotensin converting enzyme inhibitor (ACEI) or angiotensin II type I receptor blocker (ARB) in patients diagnosed as acute myocardial infarction (AMI) with non-obstructive coronary arteries (MINOCA) is not established. The purpose of this study is to compare the clinical effect of ACEI vs. ARB in MINOCA patients.

Methods and results: A total of 273 patients between November 2011 to June 2015, diagnosed with MINOCA who were registered in the Korea AMI Registry — National Institute of Health were enrolled. Patients were divided into ACEI (n = 112) and ARB groups (n = 161). The primary endpoint was cumulative incidence of major adverse cardiac events (MACE) defined as cardiac death, recurrent MI, any new revascularization during 2 years clinical follow-up. Secondary endpoint was heart failure requiring re-hospitalization. Propensity score matching analysis was done. The incidence of primary endpoint was similar (10.4% vs. 15.6%, HR: 0.65; 95% CI: 0.29–1.47; p = 0.301) among both groups. However, the incidence of recurrent MI was significantly lower in ACEI group compared to ARB group (2.1% vs. 10.4%, HR: 0.18, 95% CI: 0.04–0.86; p = 0.031).

Conclusions: In the present study, the risk and incidence of MACE was similar between ACEI and ARB therapy in MINOCA patients. However, ACEI significantly reduced the risk of recurrent MI. Further larger scale multi-center randomized clinical trials are needed to clarify the proper use of renin angiotensin aldosterone system blocker in these patients.

Abstract

Background: Selecting angiotensin converting enzyme inhibitor (ACEI) or angiotensin II type I receptor blocker (ARB) in patients diagnosed as acute myocardial infarction (AMI) with non-obstructive coronary arteries (MINOCA) is not established. The purpose of this study is to compare the clinical effect of ACEI vs. ARB in MINOCA patients.

Methods and results: A total of 273 patients between November 2011 to June 2015, diagnosed with MINOCA who were registered in the Korea AMI Registry — National Institute of Health were enrolled. Patients were divided into ACEI (n = 112) and ARB groups (n = 161). The primary endpoint was cumulative incidence of major adverse cardiac events (MACE) defined as cardiac death, recurrent MI, any new revascularization during 2 years clinical follow-up. Secondary endpoint was heart failure requiring re-hospitalization. Propensity score matching analysis was done. The incidence of primary endpoint was similar (10.4% vs. 15.6%, HR: 0.65; 95% CI: 0.29–1.47; p = 0.301) among both groups. However, the incidence of recurrent MI was significantly lower in ACEI group compared to ARB group (2.1% vs. 10.4%, HR: 0.18, 95% CI: 0.04–0.86; p = 0.031).

Conclusions: In the present study, the risk and incidence of MACE was similar between ACEI and ARB therapy in MINOCA patients. However, ACEI significantly reduced the risk of recurrent MI. Further larger scale multi-center randomized clinical trials are needed to clarify the proper use of renin angiotensin aldosterone system blocker in these patients.

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Keywords

non-obstructive coronary arteries, angiotensin converting enzyme inhibitor/angiotensin II type I receptor blocker, prognosis

About this article
Title

Comparative effect of angiotensin converting enzyme inhibitor versus angiotensin ii type i receptor blocker in acute myocardial infarction with non-obstructive coronary arteries; from the Korea Acute Myocardial Infarction Registry — National Institute of Health

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-09-28

DOI

10.5603/CJ.a2020.0130

Pubmed

33001422

Keywords

non-obstructive coronary arteries
angiotensin converting enzyme inhibitor/angiotensin II type I receptor blocker
prognosis

Authors

Joon Ho Ahn
Ju Yong Hyun
Myung Ho Jeong
Ju Han Kim
Young Joon Hong
Doo Sun Sim
Min Chul Kim
Hun-Sik Park
Doo-Il Kim
Seung-Ho Hur
Seok Kyu Oh
Youngkeun Ahn

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