Reevaluating the effect of ACEI/ARB therapy on discharged patients with STEMI in the contemporary reperfusion era.

Background: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) had beneficial effects on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) in the pre-reperfusion or thrombolytic era. It is unknown if the benefits persist in the contemporary reperfusion era.

Aims: We sought to determine if ACEI/ARB improve clinical outcomes for STEMI patients in the contemporary reperfusion era according to the reperfusion strategy.

Methods: In total, we analyzed 12 596 patients from the prospective, nationwide, multicenter China Acute Myocardial Infarction Registry. These patients were classified into the no-reperfusion group (n = 6004) and the primary percutaneous coronary intervention (PCI) group (n = 6592). Two-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) were compared.

Results: In the no-reperfusion group, ACEI/ARB therapy on discharge may reduce the incidence of 30-day MACCE (4.7% vs. 7.4%; adjusted hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.53-0.85; P <0.001), stroke (0.5% vs. 1.1%; adjusted HR, 0.41; 95% CI, 0.21-0.83; P = 0.01), and revascularization (2.1% vs. 3.1%; adjusted HR, 0.66; 95% CI, 0.46-0.94; P = 0.02), compared to patients not treated with ACEI/ARB. Patients treated with ACEI/ARB also showed a lower rate of 2-year MACCE (17.0% vs. 19.1%; adjusted HR, 0.87; 95% CI, 0.76-0.99; P = 0.04). No differences were observed in the remaining outcomes. In the primary PCI group, no differences were observed for all examined outcomes before and after multivariate adjustments.

Conclusions: Initiating ACEI/ARB treatment on discharge may reduce cardiovascular events in STEMI patients not receiving reperfusion, while no significant benefits were observed in those receiving primary PCI.