Renin–Angiotensin System Blockade and Risk of Heart Failure After Myocardial Infarction Based on Left Ventricular Ejection Fraction: A Retrospective Cohort Study

Cespón‐Fernández, María; Raposeiras‐Roubín, Sergio; Abu‐Assi, Emad; Manzano-Fernández, Sergio; Flores-Blanco, Pedro; Barreiro-Pardal, Cristina; Castiñeira-Busto, María; Muñoz-Pousa, Isabel; López-Rodríguez, Elena; Caneiro‐Queija, Berenice; Paz, Rafael Cobas; Fernández-Barbeira, Saleta; Domínguez‐Erquicia, Pablo; Domínguez-Rodríguez, Luis Manuel; Gómez-Molina, Miriam; Baz-Alonso, José Antonio; Calvo-Iglesias, Francisco; Valdés‐Chávarri, Mariano; Íñiguez‐Romo, Andrés

doi:10.1007/s40256-019-00343-7

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…Historically, randomized controlled trials of ACEI/ARB have demonstrated a reduction in mortality and hospitalization for HF among patients with AMI and both reduced LVEF 4 as well as preserved LVEF 7,25 . In contrast, several contemporary observational studies have found no reduction in mortality or hospitalization for HF associated with ACEI/ARB among patients with AMI and preserved LVEF 26,27 . Several unique features of our study population should be noted when compared with these aforementioned observational studies: there was a high prevalence of cardiovascular risk factors (31.4% diabetes, 57.5% hypertension, and 52.4% hyperlipidemia), all study participants underwent inhospital revascularization, and we were able to compare clinical outcomes between patients prescribed combination treatment with BB + ACEI/ARB, BB only, ACEI/ARB only versus no BB + no ACEI/ARB.…”

Section: Discussionmentioning

confidence: 85%

Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization

Sim

Zheng

Richards

et al. 2020

Sci Rep

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Pivotal trials of beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) in acute myocardial infarction (AMI) were largely conducted prior to the widespread adoption of early revascularization. A total of 15,073 patients with AMI who underwent inhospital coronary revascularization from January 2007 to December 2013 were analyzed. At 12 months, BB was significantly associated with a lower incidence of major adverse cardiovascular events (MACE, adjusted HR 0.80, 95% CI 0.70–0.93) and all-cause mortality (adjusted HR 0.69, 95% CI 0.55–0.88), while ACEI/ARB was significantly associated with lower all-cause mortality (adjusted HR 0.80, 95% CI 0.66–0.98) and heart failure (HF) hospitalization (adjusted HR 0.80, 95% CI 0.68–0.95). Combined BB and ACEI/ARB use was associated with the lowest incidence of MACE (adjusted HR 0.70, 95% CI 0.57–0.86), all-cause mortality (adjusted HR 0.55, 95% CI 0.40–0.77) and HF hospitalization (adjusted HR 0.64, 95% CI 0.48–0.86). This were consistent for left ventricular ejection fraction < 50% or ≥ 50%. In conclusion, in AMI managed with revascularization, both BB and ACEI/ARB were associated with a lower incidence of 12-month all-cause mortality. Combined BB and ACEI/ARB was associated with the lowest incidence of all-cause mortality and HF hospitalization.

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Section: Discussionmentioning

confidence: 85%

Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization

Sim

Zheng

Richards

et al. 2020

Sci Rep

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“…Following AMI, disordered ventricular muscle contraction, activation of the RAAS and ventricular remodeling may lead to cardiac insufficiency, or even pump failure ( 18 ). At present, the drugs that are recommended by guidelines have a low effect on inhibiting excessive activation of the nonendocrine system in the mechanism of heart failure following AMI and are unable to bring about the rapid rectification of hemodynamic disorders ( 19 , 20 ). Notably, the overall therapeutic effects of treatments often do not meet clinical expectations.…”

Section: Discussionmentioning

confidence: 99%

Protective effect of sacubitril/valsartan in patients with acute myocardial infarction: A meta‑analysis

Liu

Yin

et al. 2022

Exp Ther Med

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To evaluate the effects and safety of sacubitril/valsartan in patients with acute myocardial infarction (AMI), a total of four databases, including PubMed, Cochrane Library, Embase and Web of Science, and the ClinicalTrials.gov website were searched. Using a combination of medical subject headings and entry terms, the final search was performed in July 2021. A manual search of cross-references from the original articles was also conducted. The meta-analysis was subsequently performed with Revman 5.3 software and a total of four studies comprising 586 patients were included. The results disclosed a significant reduction in major adverse cardiovascular and cerebrovascular events (MACCEs) [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.30-0.73; P=0.0007], readmission (OR, 0.45; 95% CI, 0.29-0.71; P=0.0006), incidence of acute heart failure (AHF) (OR, 0.45; 95% CI, 0.28-0.71; P=0.0007) and N-terminal pro B-type natriuretic peptide [standardized mean difference (SMD), -0.88; 95% CI, -1.55-(-0.21); P=0.01] in the sacubitril/valsartan group compared with that in the control group, and a random effects model was used to pool these data. No significant differences were identified in the incidence of hypotension (OR, 2.91; 95% CI, 0.55-15.51; P=0.21), adverse events (OR, 2.19; 95% CI, 0.42-11.37; P=0.35), left ventricular ejection fraction (mean difference, 1.96; 95% CI, -0.84-4.76; P=0.17) or soluble suppression of tumorigenesis-2 (SMD, -0.45; 95% CI, -1.62-0.71; P=0.45) according to the random effects model. In conclusion, the present meta-analysis revealed that sacubitril/valsartan was able to effectively reduce the incidence of MACCEs, readmission and AHF in patients with AMI after revascularization without any obvious adverse events.

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“…Moreover, these results may be similar to those of the CAPRICORN (Carvedilol Post-Infarct Survival Control in LV Dysfunction) randomized trial [36], which showed that BB + RASI therapy reduced mortality in patients with AMI and reduced LVEF (≤40%) with or without HF. Additionally, María et al [37] demonstrated that, among hospitalized survivors of AMI, the use of RASI was associated with a lower risk of follow-up HF in patients with a LVEF ≤40% but not in those with a LVEF >40%. As shown in Table S3, decreased LVEF (<40%) was a significant independent predictor for both MACEs (aHR: 1.634; 95% CI: 1.302-2.018; p < 0.001) and HHF (aHR: 6.923; 95% CI: 4.897-9.832; p < 0.001) in our study.…”

Section: Discussionmentioning

confidence: 99%

Beta-Blocker and Renin–Angiotensin System Inhibitor Combination Therapy in Patients with Acute Myocardial Infarction and Prediabetes or Diabetes Who Underwent Successful Implantation of Newer-Generation Drug-Eluting Stents: A Retrospective Observational Registry Study

Kim

Her

Jeong

et al. 2020

JCM

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Long-term clinical outcomes in patients with acute myocardial infarction (AMI) and prediabetes or diabetes who received ß-blockers (BB) and renin–angiotensin system inhibitor (RASI) therapy after successful newer-generation drug-eluting stent (DES) implantation are limited. We compared the two-year clinical outcomes in such patients. A total of 9466 patients with AMI in the Korea AMI Registry were classified into six groups according to their glycemic status and presence or absence of BB + RASI therapy: normoglycemia and BB + RASI users (n = 2217) or nonusers (n = 243), prediabetes and BB + RASI users (n = 2601) or nonusers (n = 306), and diabetes and BB + RASI users (n = 3682) or nonusers (n = 417). The primary endpoint was major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat revascularization, and the secondary endpoint was the cumulative incidence of hospitalization for heart failure (HHF). In patients with BB + RASI, despite similar primary and secondary clinical points between the prediabetes and diabetes groups, the cumulative incidence of Re-MI (adjusted hazard ratio: 1.660; 95% confidence interval: 1.000–2.755; p = 0.020) was higher in the diabetes group than in the prediabetes group. In all three different glycemic groups, BB + RASI users showed reduced MACEs, cardiac death, and HHF compared to those of BB + RASI nonusers. In this retrospective observational registry study, BB + RASI therapy showed comparable clinical outcomes except for Re-MI between prediabetes and diabetes in patients with AMI during a two-year follow-up period.

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Renin–Angiotensin System Blockade and Risk of Heart Failure After Myocardial Infarction Based on Left Ventricular Ejection Fraction: A Retrospective Cohort Study

Cited by 7 publications

References 28 publications

Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization

Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization

Protective effect of sacubitril/valsartan in patients with acute myocardial infarction: A meta‑analysis

Beta-Blocker and Renin–Angiotensin System Inhibitor Combination Therapy in Patients with Acute Myocardial Infarction and Prediabetes or Diabetes Who Underwent Successful Implantation of Newer-Generation Drug-Eluting Stents: A Retrospective Observational Registry Study

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