ARBs a good alternative to ACEIs in patients with acute MI

The incidence of death is comparable between patients with acute myocardial infarction (MI) without heart failure (HF) receiving angiotensin II receptor blockers (ARBs) and those taking angiotensin-converting enzyme inhibitors (ACEIs), a study has shown.

Using the Korean nationwide medical insurance data, the authors enrolled 31,013 patients who underwent coronary revascularization for MI with prescription of ARBs or ACEIs at hospital discharge between 2010 and 2016. Those with HF at index MI were not included.

Of the patients, 12,685 (40.9 percent) were prescribed ARBs and 18,328 (59.1 percent) ACEIs. Patients in the ARB group had a lower discontinuation rate than those in the ACEI group (28.2 percent vs 43.5 percent; adjusted hazard ratio [aHR], 0.34, 95 percent confidence interval [CI], 0.31–0.37; p<0.01).

A total of 2,480 patients died during a median follow-up of 2.2 years. The incidence rate of all-cause death was 27.7 per 1,000 person-years in patients receiving ARBs and 22.9 per 1,000 person-years in those receiving ACEIs (aHR, 1.04, 95 percent CI, 0.95–1.13; p=0.40).

No significant differences were observed in other outcomes, including recurrent MI, hospitalization for new HF, and a composite of each outcome, between patients taking ARBs and those taking ACEIs, except for stroke (19.2 vs 13.6 per 1,000 person-years; aHR, 1.17, 95 percent CI, 1.04–1.32; p=0.01).

In subgroup analysis, however, there was higher mortality seen with ARBs than with ACEIs among patients with diabetes.

"ARBs would be an alternative to ACEIs for those intolerant to ACEI therapy,” the authors said.