Comparison of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with diabetes mellitus and non-ST-segment elevation myocardial infarction who underwent successful percutaneous coronary intervention
Comparison of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with diabetes mellitus and non-ST-segment elevation myocardial infarction who underwent successful percutaneous coronary intervention
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DOI：
10.1016/j.atherosclerosis.2018.08.038
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发表时间：
2018-10-01
期刊：
影响因子：
5.3
通讯作者：
Jeong, Myung Ho
中科院分区：
文献类型：
--
作者：
Byun, Jae Kyeong;Choi, Byoung Geol;Jeong, Myung Ho
背景和目的：血管紧张素转换酶抑制剂(ACEI)和血管紧张素II受体阻滞剂(ARB)对非ST段抬高型心肌梗死(NSTEMI)患者和糖尿病(DM)患者都是有益的。然而，ACEI和ARB在NSTEMI和DM患者中的疗效比较尚不清楚。本研究的目的是比较血管紧张素转换酶抑制剂(ACEI)和血管紧张素转换酶抑制剂(ARB)在非ST段抬高心肌梗死(NSTEMI)和糖尿病(DM)患者中的保护作用。方法：在韩国全国急性心肌梗死登记中心登记的53,281例患者中，3426例接受肾素-血管紧张素系统(RAS)抑制剂治疗的NSTEMI和DM患者成功地接受了经皮冠状动脉介入治疗(PCI)和药物洗脱支架(DES)。分为ACEI组(2076例)和ARB组(1350例)。比较两组患者的个体主要临床结局和主要心脏不良事件(MACE)、总死亡、心肌梗死(MI)和血管重建的综合情况。结果：经倾向得分匹配分析，产生两组倾向匹配组(1103对，总数=2206)，基线特征平衡。尽管两组的所有死亡和再发心肌梗死的原因没有差别，但血管重建率(4.0%vs.7.1%；p=0.002)，包括靶血管(2.3%vs.5.0；结论：与ARB组相比，ACEI组对各种原因的死亡、心源性死亡或心肌梗死复发均无明显益处，但ACEI组降低了血管再通和MACE的发生率。因此，需要在更大的人群中进行精心设计的试验来证实这些结果。
Background and aims: Angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are known to be beneficial for either non-ST-segment elevation myocardial infarction (NSTEMI) patients or diabetes mellitus (DM) patients. However, the comparative efficacy of ACEI versus ARB in patients with NSTEMI and DM is unclear. The aim of this study was to compare the protective efficacy of ACEI versus ARB in patients with NSTEMI and DM, who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods: Among 53,281 patients enrolled in the nationwide Korea Acute Myocardial Infarction Registry, 3426 patients with NSTEMI and DM, who were treated with renin-angiotensin system (RAS) inhibitors, had undergone successful PCI with DESs. They were classified into two groups: ACEI group (N = 2076), and ARB group (N = 1350). Individual major clinical outcomes and major adverse cardiac events (MACE), the composite of total death, myocardial infarction (MI), and revascularization were compared between the two groups for up to two years.Results: After propensity score-matching analysis, two propensity-matched groups (1103 pairs, total = 2206) were generated, and the baseline characteristics were balanced. Although all causes of death and recurrent MI were not different between the two groups, the incidence of revascularization (4.0% vs. 7.1%; p = 0.002), including target vessel (2.3% vs. 5.0; p = 0.002), and MACE (8.7% vs. 12.5%, p = 0.008), were lower in the ACEI group than the ARB group at two-year follow-up.Conclusions: Compared with ARB, no beneficial effects of ACEI on all causes of death, cardiac death, or recurrence of MI were observed, but ACEI reduced the incidence of revascularization and MACE in this population. Thus, well-designed trials with a larger population are needed to confirm these results.