IMR Press / RCM / Volume 23 / Issue 1 / DOI: 10.31083/j.rcm2301018
Open Access Original Research
Assessment of optimal renin-angiotensin-system inhibition strategy in Asian patients with STEMI after primary myocardial revascularization
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1 Division of Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 05505 Seoul, Republic of Korea
2 Division of Cardiology, Sejong General Hospital, 21080 Bucheon, Republic of Korea
3 Division of Cardiology, CHA Ilsan Medical Center, CHA University School of Medicine, 10414 Goyang, Republic of Korea
4 Division of Cardiology, Inha University Hospital, 22332 Incheon, Republic of Korea
5 Division of Cardiology, Soon Chun Hyang University Bucheon Hospital, 14584 Bucheon, Republic of Korea
6 Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21564 Incheon, Republic of Korea

These authors contributed equally.
Academic Editor: Brian Tomlinson

Rev. Cardiovasc. Med. 2022 , 23(1), 1;
Submitted: 3 June 2021 | Revised: 4 August 2021 | Accepted: 31 August 2021 | Published: 14 January 2022
(This article belongs to the Special Issue State-of-the-Art Cardiovascular Medicine in Asia 2021)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: For the Asian patients with STEMI undergoing PCI, ACEIs are known to have a better outcome than ARBs. However, there is limited evidence to suggest so. Methods: Among the STEMI registry consist of 1142 Korean patients, we compared the MACE, the composite of myocardial infarction, stoke, death, admission for heart failure, and target vessel revascularization, between the ACEI and ARB groups (Set 1). Further, we defined adequate medication as the administration of a dose equal to or higher than the initiation dose of ACEI according to the heart failure guideline recommendation with a mandatory addition of beta-blockers, and compared the outcomes between the inadequate and adequate medication groups (Set 2). Propensity score matching was used to eliminate difference. Results: In the Set 1 comparison, patients in the ACEI group had a better outcome than those in the ARB group for both whole and matched populations (whole and matched population: Cox regression hazard ratio [HR], 0.645 and 0.535; 95% confidence interval [CI], 0.440–0.944 and 0.296–0.967; p = 0.024 and p = 0.039, respectively). In the Set 2 comparison for the whole population, patients in the inadequate medication group had more MACE than those in the adequate medication group (HR, 0.673; 95% CI, 0.459–0.985; p = 0.042). However, no difference was observed after propensity score matching (HR, 1.023; 95% CI, 0.654–1.602; p = 0.919). Conclusion: ACEIs might be a better choice than ARBs after primary revascularization. However, this study’s findings suggest that early ACEI dose escalation combined with beta-blocker use may not improve prognosis.

Myocardial infarction
Renin-angiotensin-aldosterone system
ACE inhibitors
Angiotensin receptor blocker
Fig. 1.
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