The current guideline recommend that angiotensin II receptor blocker(ARB) can be used as alternative to angiotensin converting enzyme(ACE) inhibitor in post myocardial infarction (MI) patients. However, there was no study which demonstrated the benefit of ARB in MI patients with preserved left ventricular systolic function. Therefore, we investigated the long-term benefit of ARB in post-MI patients with preserved left ventricular ejection fraction (LVEF).Design and Method:
From a multicenter registry, we registered 4748 patients with acute MI. The patients who died in hospital or treated with ACE inhibitor at discharge were excluded. Total 1629 acute MI patients with preserved LVEF (≥ 45%) were analyzed. Among the enrolled patients, 948 patients were treated with ARB and 681 patients were not treated. The primary end point was all-cause mortality and secondary end point were respective incidence of cardiac death, stroke, non-fatal MI or any revascularization.Results:
The analysis in overall population showed that treatment with ARB reduced the cumulative all-cause mortality (HR = 0.624, 95% CI: 0.486–0.801, p < 0.001). Although there was no significant difference in incidence of stroke, non-fatal MI or any revascularization between two groups, the use of ARB reduced the risk of cardiac death (HR = 0.425, 95% CI: 0.286–0.632, p < 0.001). In multivariate analysis, the treatment with ARB was independently associated with reduction of all-cause death (HR = 0.766, 95% CI: 0.587–0.997, p = 0.048). The analysis in propensity-matched population revealed similar results.Conclusions:
The treatment with ARB was associated with reduced long-term mortality in MI patients with preserved systolic function. To our knowledge, this is first study which demonstrates the survival benefit of ARB in patients with preserved LVEF. This result supports the current guideline about the use of ARB in post-MI patients.