Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers Are Associated With Improved Outcome but do Not Prevent New-Onset Atrial Fibrillation After Acute Myocardial Infarction
Batra, Gorav ; Lindhagen, Lars ; Andell, Pontus LU ; Erlinge, David LU
; James, Stefan
; Spaak, Jonas
and Oldgren, Jonas
(2017)
In Journal of the American Heart Association
6(3).
- Abstract
Background-Treatment with renin-angiotensin system (RAS) inhibitors might restrain the structural/electrical remodeling associated with atrial fibrillation (AF). Limited evidence exists regarding the potential benefits of RAS inhibition post-acute myocardial infarction (AMI) in patients with AF. This study sought to assess the association between RAS inhibition and all-cause mortality and new-onset AF in patients with/without congestive heart failure (CHF) post-AMI. Methods and Results--Patients hospitalized for AMI between 2006 and 2012 were identified in Swedish registries. Patients were stratified in 4 subgroups; patients with CHF and AF (n=11 489); patients with CHF without AF (n=31 676); patients with AF without CHF (n=10 066); and... (More)
Background-Treatment with renin-angiotensin system (RAS) inhibitors might restrain the structural/electrical remodeling associated with atrial fibrillation (AF). Limited evidence exists regarding the potential benefits of RAS inhibition post-acute myocardial infarction (AMI) in patients with AF. This study sought to assess the association between RAS inhibition and all-cause mortality and new-onset AF in patients with/without congestive heart failure (CHF) post-AMI. Methods and Results--Patients hospitalized for AMI between 2006 and 2012 were identified in Swedish registries. Patients were stratified in 4 subgroups; patients with CHF and AF (n=11 489); patients with CHF without AF (n=31 676); patients with AF without CHF (n=10 066); and patients without both CHF and AF (n=59 417). Patients exposed to RAS inhibition were compared to nontreated. Three-year risk of all-cause mortality and new-onset AF was assessed using adjusted Cox regression analyses. At discharge, 83 291 (73.9%) patients received RAS inhibition. RAS inhibition was associated with lower 3-year risk of all-cause mortality in CHF patients with AF, adjusted hazard ratio (HR) with 95% CI 0.75 (0.70-0.81), CHF patients without AF, HR 0.65 (0.60-0.69), AF patients without CHF, HR 0.82 (0.75-0.90), and in patients without CHF and AF, HR 0.76 (0.72-0.81), respectively. RAS inhibition was not associated with lower 3-year risk of new-onset AF in patients without AF but with/without CHF; HR 0.96 (0.84-1.10) and 1.12 (1.02-1.22), respectively. Conclusions--RAS inhibition post-AMI was associated with lower risk of all-cause mortality. In patients with/without CHF, RAS inhibition was not associated with lower incidence of new-onset AF.
(Less)
- author
- Batra, Gorav
; Lindhagen, Lars
; Andell, Pontus
LU
; Erlinge, David
LU
; James, Stefan
; Spaak, Jonas
and Oldgren, Jonas
- organization
- publishing date
- 2017
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Atrial fibrillation, Myocardial infarction
- in
- Journal of the American Heart Association
- volume
- 6
- issue
- 3
- article number
- e005165
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85032568428
- pmid:28320744
- wos:000399322900044
- ISSN
- 2047-9980
- DOI
- 10.1161/JAHA.116.005165
- language
- English
- LU publication?
- yes
- id
- e40bb605-5096-4b76-a695-176fa904b7f3
- date added to LUP
- 2017-11-08 10:05:33
- date last changed
- 2024-04-14 21:55:02
@article{e40bb605-5096-4b76-a695-176fa904b7f3,
abstract = {{<p>Background-Treatment with renin-angiotensin system (RAS) inhibitors might restrain the structural/electrical remodeling associated with atrial fibrillation (AF). Limited evidence exists regarding the potential benefits of RAS inhibition post-acute myocardial infarction (AMI) in patients with AF. This study sought to assess the association between RAS inhibition and all-cause mortality and new-onset AF in patients with/without congestive heart failure (CHF) post-AMI. Methods and Results--Patients hospitalized for AMI between 2006 and 2012 were identified in Swedish registries. Patients were stratified in 4 subgroups; patients with CHF and AF (n=11 489); patients with CHF without AF (n=31 676); patients with AF without CHF (n=10 066); and patients without both CHF and AF (n=59 417). Patients exposed to RAS inhibition were compared to nontreated. Three-year risk of all-cause mortality and new-onset AF was assessed using adjusted Cox regression analyses. At discharge, 83 291 (73.9%) patients received RAS inhibition. RAS inhibition was associated with lower 3-year risk of all-cause mortality in CHF patients with AF, adjusted hazard ratio (HR) with 95% CI 0.75 (0.70-0.81), CHF patients without AF, HR 0.65 (0.60-0.69), AF patients without CHF, HR 0.82 (0.75-0.90), and in patients without CHF and AF, HR 0.76 (0.72-0.81), respectively. RAS inhibition was not associated with lower 3-year risk of new-onset AF in patients without AF but with/without CHF; HR 0.96 (0.84-1.10) and 1.12 (1.02-1.22), respectively. Conclusions--RAS inhibition post-AMI was associated with lower risk of all-cause mortality. In patients with/without CHF, RAS inhibition was not associated with lower incidence of new-onset AF.</p>}},
author = {{Batra, Gorav and Lindhagen, Lars and Andell, Pontus and Erlinge, David and James, Stefan and Spaak, Jonas and Oldgren, Jonas}},
issn = {{2047-9980}},
keywords = {{Atrial fibrillation; Myocardial infarction}},
language = {{eng}},
number = {{3}},
publisher = {{Wiley-Blackwell}},
series = {{Journal of the American Heart Association}},
title = {{Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers Are Associated With Improved Outcome but do Not Prevent New-Onset Atrial Fibrillation After Acute Myocardial Infarction}},
url = {{http://dx.doi.org/10.1161/JAHA.116.005165}},
doi = {{10.1161/JAHA.116.005165}},
volume = {{6}},
year = {{2017}},
}