Comparative Effectiveness of Angiotensin II Receptor Blockers Versus Angiotensin-Converting Enzyme Inhibitors Following Contemporary Treatments in Patients with Acute Myocardial Infarction: Results from the Korean Working Group in Myocardial Infarction (KorMI) Registry

Background: There are few data on the comparative effectiveness of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) in a broad spectrum of patients with acute myocardial infarction (AMI), undergoing percutaneous coronary intervention (PCI). Methods: A total of 8574 patients were selected from the prospective AMI registry, the Korean Working Group in Myocardial Infarction (KorMI) Registry, and divided into two groups on the basis of discharge prescription: ARB (n = 2281) or ACEI (n = 6293). The study was also designed using propensity-score matching (1171 patients in the ARB vs. 2752 patients in the ACEI group). The primary outcome was a composite of cardiac death or myocardial infarction (MI) during 1-year follow-up. Results: The Cox model showed both the ARB and ACEI groups had similar risk of cardiac death or MI [adjusted hazard ratio (HR) for ARB 0.69, 95 % confidence interval (CI) 0.38–1.25, p = 0.22]. This result was consistent across various risk subgroups, including patients with preserved left ventricular systolic function, or according to the Global Registry of Acute Coronary Events (GRACE) risk scoring system. After propensity-score matching, there was no significant difference in the incidence of cardiac death or MI between the groups (1.3 % in the ARB group vs. 1.7 % in the ACEI group, adjusted HR for ARB 0.68, 95 % CI 0.38–1.23, p = 0.21). The risks of all-cause death, cardiac death, or MI were also similar between groups. Conclusions: In a broad spectrum of AMI patients with interventional and pharmacologic treatments, the short-term risk of cardiac death or MI was similar between ARB and ACEI groups.