Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Myocardial Infarction Patients With Renal Dysfunction
(2016) In Journal of the American College of Cardiology 67(14). p.97-1687- Abstract
BACKGROUND: There is no consensus whether angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) should be used for secondary prevention in all or in only high-risk patients after an acute myocardial infarction (AMI).
OBJECTIVES: This study sought to investigate whether ACEI/ARB treatment after AMI is associated with better outcomes across different risk profiles, including the entire spectrum of estimated glomerular filtration rates.
METHODS: This study evaluated discharge and continuous follow-up data on ACEI/ARB use among AMI survivors (2006 to 2009) included in a large Swedish registry. The association between ACEI/ARB treatment and outcomes (mortality, myocardial infarction, stroke, and... (More)
BACKGROUND: There is no consensus whether angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) should be used for secondary prevention in all or in only high-risk patients after an acute myocardial infarction (AMI).
OBJECTIVES: This study sought to investigate whether ACEI/ARB treatment after AMI is associated with better outcomes across different risk profiles, including the entire spectrum of estimated glomerular filtration rates.
METHODS: This study evaluated discharge and continuous follow-up data on ACEI/ARB use among AMI survivors (2006 to 2009) included in a large Swedish registry. The association between ACEI/ARB treatment and outcomes (mortality, myocardial infarction, stroke, and acute kidney injury [AKI]) was studied using Cox proportional hazards models (intention-to-treat and as treated).
RESULTS: In total, 45,697 patients (71%) were treated with ACEI/ARB. The 3-year mortality was 19.8% (17.4% of ACEI/ARB users and 25.4% of nonusers). In adjusted analysis, significantly better survival was observed for patients treated with ACEI/ARB (3-year hazard ratio: 0.80; 95% confidence interval: 0.77 to 0.83). The survival benefit was consistent through all kidney function strata, including dialysis patients. Overall, those treated with ACEI/ARB also had lower 3-year risk for myocardial infarction (hazard ratio: 0.91; 95% confidence interval: 0.87 to 0.95), whereas treatment had no significant effect on stroke risk. The crude risk for AKI was in general low (2.5% and 2.0% for treated and nontreated, respectively) and similar across estimated glomerular filtration rate categories but was significantly higher with ACEI/ARB treatment. However, the composite outcome of AKI and mortality favored ACEI/ARB treatment.
CONCLUSIONS: Treatment with ACEI/ARB after AMI was associated with improved long-term survival, regardless of underlying renal function, and was accompanied by low rates of adverse renal events.
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- author
- Evans, Marie ; Carrero, Juan-Jesus ; Szummer, Karolina ; Åkerblom, Axel ; Edfors, Robert ; Spaak, Jonas ; Jacobson, Stefan H ; Andell, Pontus LU ; Lindhagen, Lars and Jernberg, Tomas
- organization
- publishing date
- 2016
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of the American College of Cardiology
- volume
- 67
- issue
- 14
- pages
- 11 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:84962135788
- wos:000373400500005
- pmid:27056774
- ISSN
- 0735-1097
- DOI
- 10.1016/j.jacc.2016.01.050
- language
- English
- LU publication?
- yes
- id
- 29021049-96bf-40e6-aa49-e55f4ef3dc0b
- date added to LUP
- 2016-04-28 15:04:57
- date last changed
- 2024-04-18 22:13:40
@article{29021049-96bf-40e6-aa49-e55f4ef3dc0b,
abstract = {{<p>BACKGROUND: There is no consensus whether angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) should be used for secondary prevention in all or in only high-risk patients after an acute myocardial infarction (AMI).</p><p>OBJECTIVES: This study sought to investigate whether ACEI/ARB treatment after AMI is associated with better outcomes across different risk profiles, including the entire spectrum of estimated glomerular filtration rates.</p><p>METHODS: This study evaluated discharge and continuous follow-up data on ACEI/ARB use among AMI survivors (2006 to 2009) included in a large Swedish registry. The association between ACEI/ARB treatment and outcomes (mortality, myocardial infarction, stroke, and acute kidney injury [AKI]) was studied using Cox proportional hazards models (intention-to-treat and as treated).</p><p>RESULTS: In total, 45,697 patients (71%) were treated with ACEI/ARB. The 3-year mortality was 19.8% (17.4% of ACEI/ARB users and 25.4% of nonusers). In adjusted analysis, significantly better survival was observed for patients treated with ACEI/ARB (3-year hazard ratio: 0.80; 95% confidence interval: 0.77 to 0.83). The survival benefit was consistent through all kidney function strata, including dialysis patients. Overall, those treated with ACEI/ARB also had lower 3-year risk for myocardial infarction (hazard ratio: 0.91; 95% confidence interval: 0.87 to 0.95), whereas treatment had no significant effect on stroke risk. The crude risk for AKI was in general low (2.5% and 2.0% for treated and nontreated, respectively) and similar across estimated glomerular filtration rate categories but was significantly higher with ACEI/ARB treatment. However, the composite outcome of AKI and mortality favored ACEI/ARB treatment.</p><p>CONCLUSIONS: Treatment with ACEI/ARB after AMI was associated with improved long-term survival, regardless of underlying renal function, and was accompanied by low rates of adverse renal events.</p>}},
author = {{Evans, Marie and Carrero, Juan-Jesus and Szummer, Karolina and Åkerblom, Axel and Edfors, Robert and Spaak, Jonas and Jacobson, Stefan H and Andell, Pontus and Lindhagen, Lars and Jernberg, Tomas}},
issn = {{0735-1097}},
language = {{eng}},
number = {{14}},
pages = {{97--1687}},
publisher = {{Elsevier}},
series = {{Journal of the American College of Cardiology}},
title = {{Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Myocardial Infarction Patients With Renal Dysfunction}},
url = {{http://dx.doi.org/10.1016/j.jacc.2016.01.050}},
doi = {{10.1016/j.jacc.2016.01.050}},
volume = {{67}},
year = {{2016}},
}