Comparative assessment of angiotensin ii type 1 receptor blockers in the treatment of acute myocardial infarction: surmountable vs. insurmountable antagonist

Title
Comparative assessment of angiotensin ii type 1 receptor blockers in the treatment of acute myocardial infarction: surmountable vs. insurmountable antagonist
Author(s)
김영조정해창[정해창]정명호[정명호]안영근[안영근]채성철[채성철]허승호[허승호]홍택종[홍택종]성인환[성인환]채인호[채인호]조명찬[조명찬]
Keywords
HEART-FAILURE; AT(1)-RECEPTOR BLOCKERS; COST-EFFECTIVENESS; AT(1) RECEPTOR; CANDESARTAN; LOSARTAN; BLOCKADE; ASSOCIATION; MORTALITY; OUTCOMES
Issue Date
201401
Publisher
ELSEVIER IRELAND LTD
Citation
INTERNATIONAL JOURNAL OF CARDIOLOGY, v.170, no.3, pp.291 - 297
Abstract
Background: The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBsmay not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). Methods: We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. Results: In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p = 0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p = 0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p = 0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. Conclusions: In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI. (C) 2013 Published by Elsevier Ireland Ltd.
URI
http://hdl.handle.net/YU.REPOSITORY/33561http://dx.doi.org/10.1016/j.ijcard.2013.07.146
ISSN
0167-5273
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의과대학 > 내과학교실 > Articles
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