Comparative assessment of angiotensin ii type 1 receptor blockers in the treatment of acute myocardial infarction

Surmountable vs. insurmountable antagonist

Hae Chang Jeong, Myung Ho Jeong, Youngkeun Ahn, Shung Chull Chae, Seung Ho Hur, Taek Jong Hong, Young Jo Kim, In Whan Seong, Jei Keon Chae, Jay Young Rhew, In Ho Chae, Myeong Chan Cho, Jang Ho Bae, Seung-Woon Rha, Chong Jin Kim, Donghoon Choi, Yang Soo Jang, Junghan Yoon, Wook Sung Chung, Jeong Gwan Cho & 2 others Ki Bae Seung, Seung Jung Park

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). Methods We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. Results In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p = 0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p = 0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p = 0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. Conclusions In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.

Original languageEnglish
Pages (from-to)291-297
Number of pages7
JournalInternational Journal of Cardiology
Volume170
Issue number3
DOIs
Publication statusPublished - 2014 Jan 1

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Angiotensin II Type 1 Receptor Blockers
Myocardial Infarction
Therapeutics
Propensity Score
Percutaneous Coronary Intervention
Korea
Coronary Artery Bypass
Stroke Volume
Observational Studies
Prescriptions
Registries
Retrospective Studies
Transplants
Kidney

Keywords

  • Angiotensin
  • Myocardial infarction
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparative assessment of angiotensin ii type 1 receptor blockers in the treatment of acute myocardial infarction : Surmountable vs. insurmountable antagonist. / Jeong, Hae Chang; Jeong, Myung Ho; Ahn, Youngkeun; Chae, Shung Chull; Hur, Seung Ho; Hong, Taek Jong; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Rhew, Jay Young; Chae, In Ho; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung-Woon; Kim, Chong Jin; Choi, Donghoon; Jang, Yang Soo; Yoon, Junghan; Chung, Wook Sung; Cho, Jeong Gwan; Seung, Ki Bae; Park, Seung Jung.

In: International Journal of Cardiology, Vol. 170, No. 3, 01.01.2014, p. 291-297.

Research output: Contribution to journalArticle

Jeong, HC, Jeong, MH, Ahn, Y, Chae, SC, Hur, SH, Hong, TJ, Kim, YJ, Seong, IW, Chae, JK, Rhew, JY, Chae, IH, Cho, MC, Bae, JH, Rha, S-W, Kim, CJ, Choi, D, Jang, YS, Yoon, J, Chung, WS, Cho, JG, Seung, KB & Park, SJ 2014, 'Comparative assessment of angiotensin ii type 1 receptor blockers in the treatment of acute myocardial infarction: Surmountable vs. insurmountable antagonist', International Journal of Cardiology, vol. 170, no. 3, pp. 291-297. https://doi.org/10.1016/j.ijcard.2013.07.146
Jeong, Hae Chang ; Jeong, Myung Ho ; Ahn, Youngkeun ; Chae, Shung Chull ; Hur, Seung Ho ; Hong, Taek Jong ; Kim, Young Jo ; Seong, In Whan ; Chae, Jei Keon ; Rhew, Jay Young ; Chae, In Ho ; Cho, Myeong Chan ; Bae, Jang Ho ; Rha, Seung-Woon ; Kim, Chong Jin ; Choi, Donghoon ; Jang, Yang Soo ; Yoon, Junghan ; Chung, Wook Sung ; Cho, Jeong Gwan ; Seung, Ki Bae ; Park, Seung Jung. / Comparative assessment of angiotensin ii type 1 receptor blockers in the treatment of acute myocardial infarction : Surmountable vs. insurmountable antagonist. In: International Journal of Cardiology. 2014 ; Vol. 170, No. 3. pp. 291-297.
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abstract = "Background The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). Methods We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. Results In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3{\%} vs. 11.2{\%}, p = 0.025), which was mainly due to increased cardiac death (3.3{\%} vs. 1.9{\%}, p = 0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9{\%} vs. 11.4{\%}, p = 0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40{\%}, with a low killip class, with ST segment elevation MI, and with normal renal function. Conclusions In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.",
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AU - Jeong, Hae Chang

AU - Jeong, Myung Ho

AU - Ahn, Youngkeun

AU - Chae, Shung Chull

AU - Hur, Seung Ho

AU - Hong, Taek Jong

AU - Kim, Young Jo

AU - Seong, In Whan

AU - Chae, Jei Keon

AU - Rhew, Jay Young

AU - Chae, In Ho

AU - Cho, Myeong Chan

AU - Bae, Jang Ho

AU - Rha, Seung-Woon

AU - Kim, Chong Jin

AU - Choi, Donghoon

AU - Jang, Yang Soo

AU - Yoon, Junghan

AU - Chung, Wook Sung

AU - Cho, Jeong Gwan

AU - Seung, Ki Bae

AU - Park, Seung Jung

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N2 - Background The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). Methods We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. Results In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p = 0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p = 0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p = 0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. Conclusions In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.

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