Mortality benefit of long-term angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after successful percutaneous coronary intervention in non-ST elevation acute myocardial infarction

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• 作者：Marí ; a Cristina Gonzá ; lez-Cambeiro^a ; ¹ ; ^{cambe_cris@hotmail.com} ; Andrea Ló ; pez-Ló ; pez^b ; ¹ ; Emad Abu-Assi^b ; Sergio Raposeiras-Roubí ; n^b ; Carlos Peñ ; a-Gil^b ; José ; Garcí ; a-Acuñ ; a^b ; Ramó ; n Gonzá ; lez-Juanatey^b
• 关键词：Angiotensin-converting enzyme inhibitors ; Angiotensin receptor blockers ; Mortality ; Non-ST elevation myocardial infarction
• 刊名：Revista Portuguesa de Cardiologia (English Edition)
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：35
• 期：12
• 页码：645-653
• 全文大小：439 K
• 卷排序：35

文摘

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to reduce mortality after myocardial infarction (MI). Current guidelines recommend their prescription in all patients after MI. Limited data are available on whether ACEIs/ARBs still improve prognosis in the contemporary era of non-ST elevation MI (NSTEMI) management. We aimed to evaluate the mortality benefit of ACEIs/ARBs in NSTEMI patients treated successfully with percutaneous coronary intervention (PCI).MethodsWe analyzed 2784 patients with NSTEMI treated successfully with in-hospital PCI. Two groups were formed based on ACEI/ARB prescription at discharge. Two propensity score (PS) analyses were performed to control for differences in covariates: one with adjustment among the entire cohort, and the other with PS matching (n=1626). The outcome variable was all-cause mortality at four-year follow-up.ResultsThere were 1902 (68.3%) patients prescribed ACEIs/ARBs at discharge. When adjusted by PS, ACEI/ARB use was associated with a hazard ratio (HR) for mortality of 0.75 (0.60-0.94; absolute risk reduction [ARR] 4.0%) in the whole cohort (p=0.01).After one-to-one PS matching (n=813 in each group), the mortality rate was significantly lower in patients prescribed ACEIs/ARBs, with HR of 0.77 (0.63-0.94; ARR 3.8%) (p=0.03).ConclusionsIn this observational study of patients with NSTEMI, all of them treated successfully by PCI, the use of ACEIs/ARBs was significantly associated with a lower risk of four-year all-cause mortality.