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Observational Study
. 2022 Oct 21;101(42):e30846.
doi: 10.1097/MD.0000000000030846.

Association of the medical therapy with beta-blockers or inhibitors of renin-angiotensin system with clinical outcomes in patients with mildly reduced left ventricular ejection fraction after acute myocardial infarction

Seung-Jae Joo  1   2 , Song-Yi Kim  1   2 , Jae-Geun Lee  1   2 , Jong Wook Beom  1   2 , Joon-Hyouk Choi  1   2 , Hyeung Keun Park  3 , Ki Yung Boo  2 , Chang-Hwan Yoon  4 , Jung-Hee Lee  5 , Jei Keon Chae  6 , Myung Ho Jeong  7 ; KAMIR-NIH registry investigators
Affiliations
Observational Study

Association of the medical therapy with beta-blockers or inhibitors of renin-angiotensin system with clinical outcomes in patients with mildly reduced left ventricular ejection fraction after acute myocardial infarction

Seung-Jae Joo et al. Medicine (Baltimore). .

Abstract

In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mildly reduced left ventricular ejection fraction (EF) (41%-49%) have been increasing. This observational study aimed to investigate the association between the medical therapy with oral beta-blockers or inhibitors of renin-angiotensin system (RAS) and 2-year clinical outcomes in patients with mildly reduced EF after AMI. Among patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health, propensity-score matched patients who survived the initial attack and had mildly reduced EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Beta-blocker therapy at discharge was associated with lower 2-year major adverse cardiac events which was a composite of cardiac death, myocardial infarction, revascularization and re-hospitalization due to heart failure (8.7 vs 12.8/100 patient-years; hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.50-0.93; P = .015), and no significant interaction between EF ≤ 45% and > 45% was observed (Pinteraction = 0.354). This association was mainly driven by lower myocardial infarction in patients with beta-blockers (HR 0.50; 95% CI 0.26-0.95; P = .035). Inhibitors of RAS at discharge were associated with lower re-hospitalization due to heart failure (1.8 vs 3.5/100 patient-years; HR 0.53; 95% CI 0.33-0.86; P = .010) without a significant interaction between EF ≤ 45% and > 45% (Pinteraction = 0.333). In patients with mildly reduced EF after AMI, the medical therapy with beta-blockers or RAS inhibitors at discharge was associated with better 2-year clinical outcomes.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Selection of patients for analysis. BB = beta-blockers, Echo = echocardiography, KAMIR-NIH = Korean Acute Myocardial Infarction Registry-National Institute of Health, LVEF = left ventricular ejection fraction, PSM = propensity score-matching, RASI = inhibitors of renin-angiotensin system.
Figure 2.
Figure 2.
Kaplan–Meier curves and adjusted hazard ratios with 95% confidence intervals for 2-year events with versus without beta-blockers at discharge in the propensity score-matched cohorts. (A) major adverse cardiac events (B) myocardial infarction (C) revascularization (D) cardiac death. BB = beta-blockers, CI = confidence interval, HR = hazard ratio, MACE = major adverse cardiac events.
Figure 3.
Figure 3.
Adjusted hazard ratios of 2-year major adverse cardiac events for subgroups in the propensity score-matched cohort with versus without beta-blockers at discharge. CI = confidence interval’ eGFR = estimated glomerular filtration rate by MDRD equation, NSTEMI = non-ST elevation myocardial infarction, STEMI = ST-elevation myocardial infarction.
Figure 4.
Figure 4.
Adjusted hazard ratios of 2-year major adverse cardiac events in the propensity score-matched cohort according to generic names of beta-blockers at discharge. (A) adjusted hazard ratios with versus without beta-blockers (B) adjusted hazard ratios among beta-blockers. CI = confidence interval.
Figure 5.
Figure 5.
Kaplan–Meier curves and adjusted hazard ratios with 95% confidence intervals for 2-year events with versus without inhibitors of renin-angiotensin system at discharge in the propensity score-matched cohorts. (A) major adverse cardiac events (B) re-hospitalization due to heart failure (C) myocardial infarction (D) cardiac death. CI = confidence interval, HR = hazard ratio, MACE = major adverse cardiac events, RASI = inhibitors of renin-angiotensin system.
Figure 6.
Figure 6.
Adjusted hazard ratios of 2-year re-hospitalization due to heart failure for subgroups in the propensity score-matched cohort with versus without inhibitors of renin-angiotensin system at discharge. CI = confidence interval, eGFR = estimated glomerular filtration rate by MDRD equation, NSTEMI = non-ST elevation myocardial infarction, STEMI = ST-elevation myocardial infarction.
Figure 7.
Figure 7.
Adjusted hazard ratios of 2-year re-hospitalization due to heart failure for angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers at discharge in the propensity score-matched cohort. ACEI = angiotensin-converting enzyme inhibitors, ARB = angiotensin receptor blockers, CI = confidence interval.
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References

    1. Ponikowski P, Voors AA, Anker SD, et al. . 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129–200. - PubMed
    1. McDonagh TA, Metra M, Adamo M, et al. . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599–726. - PubMed
    1. The CAPRICON Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001;357:1385–90. - PubMed
    1. Flather MD, Yusuf S, Køber L, et al. . Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet. 2000;355:1575–81. - PubMed
    1. Pfeffer MA, McMurray JJ, Velazquez EJ, et al. . Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349:1893–906. - PubMed

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