open access

Vol 28, No 5 (2021)
Original Article
Submitted: 2020-03-31
Accepted: 2020-07-21
Published online: 2020-09-28
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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 Ahn1, Ju Yong Hyun1, Myung Ho Jeong1, Ju Han Kim1, Young Joon Hong1, Doo Sun Sim1, Min Chul Kim1, Hun-Sik Park2, Doo-Il Kim3, Seung-Ho Hur4, Seok Kyu Oh5, Youngkeun Ahn1
DOI: 10.5603/CJ.a2020.0130
·
Pubmed: 33001422
·
Cardiol J 2021;28(5):738-745.
Affiliations
  1. Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
  2. Department of Cardiology, Kyungpuk National University Hospital, Daegu, Korea
  3. Department of Cardiology, Inje University Haeundae Paik Hospital, Busan, Korea
  4. Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
  5. Department of Cardiology, Wonkwang University Hospital, Iksan, Korea

open access

Vol 28, No 5 (2021)
Original articles — Clinical cardiology
Submitted: 2020-03-31
Accepted: 2020-07-21
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 Acute Myocardial Infarction 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 Acute Myocardial Infarction 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

Vol 28, No 5 (2021)

Article type

Original Article

Pages

738-745

Published online

2020-09-28

Page views

5399

Article views/downloads

873

DOI

10.5603/CJ.a2020.0130

Pubmed

33001422

Bibliographic record

Cardiol J 2021;28(5):738-745.

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

References (24)
  1. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127(4): 529–555.
  2. DeWood MA, Spores J, Hensley GR, et al. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980; 303(16): 897–902.
  3. Agewall S, Beltrame JF, Reynolds HR, et al. et al.. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017; 38(3): 143–153.
  4. Patel MR, Chen AY, Peterson ED, et al. Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative. Am Heart J. 2006; 152(4): 641–647.
  5. Pasupathy S, Air T, Dreyer RP, et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015; 131(10): 861–870.
  6. Larsen AI, Galbraith PD, Ghali WA, et al. Characteristics and outcomes of patients with acute myocardial infarction and angiographically normal coronary arteries. Am J Cardiol. 2005; 95(2): 261–263.
  7. Safdar B, Spatz ES, Dreyer RP, et al. Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study. J Am Heart Assoc. 2018; 7(13).
  8. Planer D, Mehran R, Ohman EM, et al. Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: propensity-matched analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. Circ Cardiovasc Interv. 2014; 7(3): 285–293.
  9. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
  10. Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016; 37(27): 2129–2200.
  11. Pasupathy S, Tavella R, Beltrame JF. Myocardial infarction with nonobstructive coronary arteries (MINOCA): the past, present, and future management. Circulation. 2017; 135(16): 1490–1493.
  12. Cutlip DE, Windecker S, Mehran R, et al. Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007; 115(17): 2344–2351.
  13. Pasupathy S, Tavella R, Beltrame JF. The what, when, who, why, how and where of myocardial infarction with non-obstructive coronary arteries (MINOCA). Circ J. 2016; 80(1): 11–16.
  14. Kang WYu, Jeong MHo, Ahn YK, et al. Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe? Int J Cardiol. 2011; 146(2): 207–212.
  15. Rossini R, Capodanno D, Lettieri C, et al. Long-term outcomes of patients with acute coronary syndrome and nonobstructive coronary artery disease. Am J Cardiol. 2013; 112(2): 150–155.
  16. Beltrame JF. Assessing patients with myocardial infarction and nonobstructed coronary arteries (MINOCA). J Intern Med. 2013; 273(2): 182–185.
  17. Niccoli G, Scalone G, Crea F. Acute myocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management. Eur Heart J. 2015; 36(8): 475–481.
  18. Lindahl B, Baron T, Erlinge D, et al. Medical therapy for secondary prevention and long-term outcome in patients with myocardial infarction with nonobstructive coronary artery disease. Circulation. 2017; 135(16): 1481–1489.
  19. Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003; 349(20): 1893–1906.
  20. Dickstein K, Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan. Lancet. 2002; 360(9335): 752–760.
  21. Strauss MH, Hall AS. The divergent cardiovascular effects of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on myocardial infarction and death. Prog Cardiovasc Dis. 2016; 58(5): 473–482.
  22. Duchene J, Bader M. Bradykinin B2 receptor agonism: a novel therapeutic strategy for myocardial infarction? Am J Hypertens. 2010; 23(5): 459.
  23. Dézsi CA. Differences in the clinical effects of angiotensin-converting enzyme inhibitors and Angiotensin receptor blockers: a critical review of the evidence. Am J Cardiovasc Drugs. 2014; 14(3): 167–173.
  24. Tornvall P, Gerbaud E, Behaghel A, et al. Myocarditis or "true" infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: A meta-analysis of individual patient data. Atherosclerosis. 2015; 241(1): 87–91.

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