AUTHOR=Park Chan Soon , Yang Han-Mo , Kang Jeehoon , Han Jung-Kyu , Park Kyung Woo , Kang Hyun-Jae , Koo Bon-Kwon , Seung Ki-Bae , Cha Kwang Soo , Seong In-Whan , Rha Seung-Woon , Jeong Myung Ho , Kim Hyo-Soo 

TITLE=Long-term use of renin-angiotensin-system inhibitors after acute myocardial infarction is not associated with survival benefits: Analysis of data from the Korean acute myocardial infarction registry-national institutes of health registry

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.994419

DOI=10.3389/fcvm.2022.994419

ISSN=2297-055X

ABSTRACT=<sec><title>Introduction</title><p>Renin-angiotensin-system inhibitors (RASi) have shown survival benefits after acute myocardial infarction (MI), but the role of routine long-term use of RASi remains unclear. Thereby, we explored the therapeutic effects of RASi medication at 1-year follow-up from acute MI.</p></sec><sec><title>Methods</title><p>Using the nationwide Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) registry, we included and analyzed 10,822 subjects. Patients were stratified into those taking RASi at 1-year follow-up (<italic>n</italic> = 7,696) and those not taking RASi at 1-year follow-up (<italic>n</italic> = 3,126). Patients were followed up for 2-years from the 1-year follow-up; 2-year all-cause mortality and cardiac mortality were analyzed as primary and secondary outcomes, respectively.</p></sec><sec><title>Results</title><p>The use of RASi at 1-year follow-up was not associated with decreased all-cause mortality (log-rank <italic>P</italic> = 0.195) or cardiac mortality (log-rank <italic>P</italic> = 0.337). In multivariate analyses, RASi medication at 1-year follow-up did not reduce all-cause mortality (<italic>P</italic> = 0.758) or cardiac mortality (<italic>P</italic> = 0.923), while RASi medication at discharge substantially reduced 1-year all-cause and cardiac mortality. Treatment with either an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker at 1-year follow-up did not show survival benefits from 1-year follow-up, respectively. The use of RASi at 1-year follow-up did not show a prognostic interaction between previous history of chronic kidney disease, post-MI acute heart failure, concomitant use of beta-blockers at 1-year follow-up, or 1-year LVEF.</p></sec><sec><title>Conclusion</title><p>Acute MI patients taking RASi at 1-year follow-up were not associated with improved 2-year all-cause mortality or cardiac mortality from the 1-year follow-up. This study provides valuable information regarding tailored medication strategy after acute MI.</p></sec><sec><title>Clinical trial registration</title><p>[<ext-link ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link>], identifier [KCT0000863].</p></sec>