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OACIS: ACE inhibitors led to better survival rates after acute MI
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Patients prescribed ACE inhibitors had better survival rates after acute MI than those prescribed angiotensin II receptor blockers, according to new data.
Researchers conducted the Osaka Acute Coronary Insufficiency Study (OACIS), a prospective, multicenter, observational study that enrolled consecutive patients with acute MI at 25 hospitals in the Osaka region of Japan and compared 5-year survival benefits of ACE inhibitors and angiotensin II receptor blockers in that population.
Participants were stratified by whether they were treated with ACE inhibitors (n=4,425), angiotensin II receptor blockers (2,158) or neither (n=2,442) at discharge. The primary endpoint was all-cause death. Secondary endpoints were HF hospitalization and nonfatal recurrent MI. Follow-up data were obtained for 5 years for patients discharged alive.
For direct comparison between those prescribed ACE inhibitors and those prescribed angiotensin II receptor blockers, the researchers used a propensity score-matched analysis.
During the study period, 661 deaths were reported, Masahiko Hara, MD, and colleagues found.
Compared with treatment with neither ACE inhibitors nor angiotensin II receptor blockers, treatment with ACE inhibitors was associated with reduced 5-year mortality (adjusted HR=0.7; 95% CI, 0.58-0.83), as was treatment with angiotensin II receptor blockers (adjusted HR=0.79; 95% CI, 0.64-0.98), Hara, of Osaka University Graduate School of Medicine, Suita, Japan, and colleagues found.
When Hara and colleagues conducted the propensity score-matched analysis for those prescribed ACE inhibitors and those prescribed angiotensin II receptor blockers, they found that ACE inhibitors were linked to better survival compared with angiotensin II receptor blockers from 2 to 5 years after discharge (adjusted HR=0.53; 95% CI, 0.38-0.74).
That the survival curves for the two classes of drugs were similar for 2 years after discharge was consistent with the OPTIMAAL and VALIANT trials, the researchers wrote. The superiority of ACE inhibitors between 2 and 5 years is partly consistent with results of a prior meta-analysis, they wrote.
“We speculate that the method for superiority of ACE [inhibitors] over [angiotensin II receptor blocker] treatment may be explained by a reduction in angiotensin II production and activation of the kallikrein-bradykinin system with ACE [inhibitor] treatment or prolonged elevation of angiotensin II levels and possible upregulation of angiotensin type 1 receptor with [angiotensin II receptor blocker] treatment,” Hara and colleagues wrote.
Disclosure: The study was funded by the Japanese Ministry of Education, Culture, Sports, Science and Technology. One researcher reports receiving research grants and speakers’ fees from Astellas Pharma, Boehringer Ingelheim, Daiichi Sankyo, Novartis, Shionogi and Takeda Pharmaceutical Co.
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