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ȣ - 520854 65 |
| Predictors and clinical outcomes of use of angiotensin-converting-enzyme inhibitor in paients with acute myocardial infarction. |
| Korea Acute Myocardial infarction Registry Investigators |
| 이장훈, 정명호, 안영근, 채성철, 김종현, 성인환, 김영조, 허승호, 최동훈, 홍택종, 윤정한, 류제영, 채제건, 김두일, 채인호, 구본권, 김병옥, 이내희, 황진용, 오석규, 조명찬, 김기식, 정경태, 이명용, 김종진, 정욱성, 장양수, 승기배, 박승정 외 KAMIR 연구자 |
BACKGROUND AND OBJECTIVES: Angiotensin-converting-enzyme inhibitors (ACE-Is) reduce major adverse cardiovascular events (MACE) among patients with myocardial infarction (MI). We investigated predictors and 6-month MACE of use of ACE-Is in the Korea Acute Myocardial Infarction Registry (KAMIR) patients. METHOD: Between November 2005 and January 2008, 10228 post-MI survivors (7337 males and 2891 females; mean age=64.1±12.5 year-old) who did not have any contraindications to ACE-Is/ARBs were analyzed. We considered hypotension (systolic blood pressure <90mmHg) and severe renal dysfunction (serum creatinine > 2.5 mg/dL in men or >2.0 mg/dL in women) as contraindications to ACE-Is. RESULTS: Of 10228 patients, 8370 were prescribed ACE-Is (66.4%) or ARBs (15.4%) and 1858 (18.2%) were prescribed neither ACE-Is nor ARBs at discharge. In multivariate analysis, history of hypertension (odds ratio [OR] 1.129, 95% confidence interval [CI] 1.003 to 1.270, p=0.044), ST elevation MI (OR 1.157, 95%CI 1.029 to 1.302, p=0.015), use of beta-blockers (OR 3.244, 95%CI 2.896 to 3.634, p<0.001), use of lipid-lowering drugs (OR 1.532, 95%CI 1.352 to 1.736, p<0.001), and renal dysfunction (serum creatinine >1.5mg/dl) (OR 1.292, 95%CI 1.049 to 1.591, p=0.016) were independent predictors of use of ACE-Is/ARBs at discharge. Compared with ARBs only group, males (OR 1.297, 95%CI 1.104 to 1.524, p=0.002), history of ischemic heart disease (OR 0.753, 95%CI 0.640 to 1.886, p=0.001), hypertension (OR 0.726, 95%CI 0.638 to 0.828, p<0.001), Killip class≥2 (OR 0.747, 95%CI 0.648 to 1.726, p<0.001), renal dysfunction (OR 0.679, 95%CI 0.560 to 0.825, p<0.001), and use of beta-blockers (OR 1.856, 95%CI 1.621 to 2.125, p<0.001) were independent predictors of use of ACE-Is. During 6 months follow-up, there was no significant difference in 6-month MACE including death, recurrent myocardial infarction, revascularization among three groups (neither: 4.9%, ACE inhibitors alone: 5.1%, ARBs alone: 5.4%, p=0.570). CONCLUSIONS: About one-fifth of post-MI patients with no contraindications to ACE-Is were not taking ACE-Is or ARBs at discharge. There was no significant difference in the short-term prognosis among ACE-I, ARBs, and neither treatment groups.
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