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Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Myocardial Infarction Patients With Renal Dysfunction

Evans, Marie; Carrero, Juan-Jesus; Szummer, Karolina; Åkerblom, Axel; Edfors, Robert; Spaak, Jonas; Jacobson, Stefan H; Andell, Pontus LU ; Lindhagen, Lars and Jernberg, Tomas (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
organization
publishing date
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
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
2017-01-01 08:24:07
@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},
  volume       = {67},
  year         = {2016},
}