Effect of renin-angiotensin system inhibitors on long-term survival in patients treated with beta blockers and antiplatelet agents after acute myocardial infarction (from the MONICA/KORA Myocardial Infarction Registry).

Abstract

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have shown to decrease mortality and cardiovascular morbidity especially in high-risk patients after acute myocardial infarction (AMI). Aim of this study was to assess the association between ACEI or ARB treatment (ACEI/ARB) at hospital discharge and long-term survival after AMI in real-life patient care. From a German population-based AMI registry, 3,544 patients (75.4% men), aged 28 to 74 years, hospitalized with an incident AMI between 2000 and 2008, surviving at least 24 hours and treated with β blockers and antiplatelet agents at discharge were included in this study. All data were collected by standardized interviews and chart review. End point of this study was all-cause mortality at 3 follow-up periods: 1, 3, and 5 years after AMI. Mortality was assessed for all registered patients in 2010. Survival analyses and multivariable Cox regression analyses were conducted. Of the 3,544 patients, 83.7% received ACEI/ARB and 90.1% were treated with statins at hospital discharge. During a median follow-up period of 5.0 years (interquartile range 1.0 years), 9.3% patients died. In the multivariable Cox models adjusting for a number of covariates, use of ACEI/ARB showed a significantly inverse relation with 1-, 3-, and 5-year mortality (e.g., 5-year mortality: hazard ratio 0.74, 95% confidence interval 0.59 to 0.94, p = 0.015), and the hazard ratios for mortality did not differ significantly between the 3 examined follow-up periods. In conclusion, use of ACEI/ARB at hospital discharge is independently associated with long-term survival benefit in patients with incident AMI already treated with other guideline-recommended cardiovascular drugs.

• Authors: Ute Amann, Inge Kirchberger, Margit Heier, Angelika Zirngibl, Wolfgang von Scheidt, Bernhard Kuch, Annette Peters, Christa Meisinger
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 114 Issue 3 Pg. 329-35 (Aug 01 2014) ISSN: 1879-1913 [Electronic] United States
• PMID: 24927969 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Platelet Aggregation Inhibitors

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Aged
• Angiotensin II Type 1 Receptor Blockers (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Germany (epidemiology)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Male
• Middle Aged
• Myocardial Infarction (drug therapy, mortality)
• Platelet Aggregation Inhibitors (therapeutic use)
• Proportional Hazards Models
• Registries
• Renin-Angiotensin System (drug effects)
• Retrospective Studies
• Survival Rate (trends)
• Time Factors
• Treatment Outcome