Introduction: Angiotensin converting enzyme inhibitors (ACEi) reduce mortality in patients with acute myocardial infarction (AMI) and heart failure. Recent trials showed that angiotensin receptor blockers (ARB) was not inferior to ACEi with better tolerability. Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease. ACEi and ARB were also key drugs for slowing the progression of CKD
Hypothesis: This study sought to assess the clinical outcomes and efficacy of ACEi compared to ARB in patients with AMI and renal dysfunction. And the use of ACEi or ARB might show better clinical outcomes.
Methods: A total of 3057 patients with renal dysfunction (CKD-EPI estimated glomerular filtration rate <60mL/min/1.73m2) who undertook percutaneous coronary intervention (PCI) were analyzed from the Korea Acute Myocardial Infarction Registry (KAMIR). They were divided into three groups [Group I: ACEi (n=1511), Group II: ARB (n=921), Group III: neither treatment (n=625)]. The cumulative incidence of major adverse cardiac events (MACEs) and independent predictors of MACEs were investigated.
Results: Over a median follow-up nearly 360 days, MACEs had occurred in 202 patients (13.37%) in Group I, 181 patients (19.67%) in Group II, and 90 patients (14.40%) in Group III (p=0.034). Group I (ACEi) showed better clinical outcomes compared with Group II (ARB). There were no differences between other groups (Group I and Group III, Group II and Group III). By univariate analysis, use of ACEi or ARB was an independent predictor of MACEs in patients with renal dysfunction who underwent PCI. ACEi had protective effect for MACEs (hazard ratio 0.796, 95% confidence interval 0.665-0.952, p=0.013), but ARB showed the opposite effect to ACEi not an independent predictor (hazard ratio 1.281, 95% confidence interval 1.068-1.537, p=0.008).
Conclusions: The use of ACEi showed better clinical outcomes compared with ARB in patients with renal dysfunction who underwent PCI.