ACE Inhibitors and ARBs Linked to Improved Long-Term Survival After Myocardial Infarction

(HealthDay News) – For acute myocardial infarction (AMI) survivors, angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) treatment is associated with improved long-term survival, according to research published in the Journal of the American College of Cardiology.

Marie Evans, MD, PhD, from the Karolinska Institutet in Stockholm, and colleagues examined discharge and continuous follow-up data on ACEI/ARB use among AMI survivors (2006 to 2009) from a large Swedish registry.

The researchers found that 45 697 patients (71%) were treated with ACEI/ARB. Overall, the 3-year mortality was 19.8% (17.4% and 25.4% among users and non-users, respectively). Survival was significantly better for patients treated with ACEI/ARB in adjusted analysis (3-year hazard ratio [HR]: 0.80), with survival benefit consistent across all kidney function strata, including dialysis patients. The 3-year risk for myocardial infarction was lower for those treated with ACEI/ARB (HR: 0.91), while no significant effect was seen for stroke risk. In general, the crude risk for acute kidney injury (AKI) was low (2.5 for treated and 2.0 for non-treated patients), and was similar across categories of estimate glomerular filtration rate; the risk was significantly higher with ACEI/ARB treatment. ACEI/ARB treatment was favored for the composite of AKI and mortality.

“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,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

References

1. Evans M, Carrero JJ, Szummer K, et al. Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Myocardial Infarction Patients with Renal Dysfunction. J Am Coll Cardiol. 2016;67(14):1687-1697. doi:10.1016/j.jacc.2016.01.050.
2. Cohn JN. Slowing the Progression of Cardiovascular Disease. J Am Coll Cardiol. 2016;67(14):1698-1700. doi:10.1016/j.jacc.2016.02.008.