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Renin–Angiotensin System Blockade and Risk of Heart Failure After Myocardial Infarction Based on Left Ventricular Ejection Fraction: A Retrospective Cohort Study

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Abstract

Introduction

The goal of this study was to determine the association between the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and follow-up heart failure (HF) according to left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction (AMI).

Methods

This cohort study used a retrospective registry of 8169 consecutive patients discharged with a diagnosis of AMI from two university hospitals in Spain between 2010 and 2016. We used a multivariable competing risk analysis, survival-time inverse probability weighting (IPW) propensity score adjusting, and propensity score matching (PSM) to investigate the association between ACEI/ARB treatment and follow-up HF.

Results

During the follow-up (3.3 ± 2.2 years), 1296 patients were admitted for HF (5.2 per 100 person-years). ACEI/ARB use was not associated with fewer follow-up HF admissions in patients with LVEF > 40% (univariate analysis: sub-hazard ratio [sHR] 1.10; 95% confidence interval [CI] 0.95–1.27; p = 0.197; IPW adjusting analysis: sHR 1.11; 95% CI 0.95–1.29; p = 0.192; PSM analysis: sHR 1.12; 95% CI 0.92–1.36; p = 0.248). However, ACEI/ARB use was associated with a significant reduction in HF admission rates in patients with LVEF ≤ 40% (univariate analysis: HR 0.70; 95% CI 0.56–0.88; p = 0.003; IPW adjusting analysis: HR 0.64; 95% CI 0.50–0.83; p = 0.001; PSM analysis: HR 0.65; 95% CI 0.46–0.92; p = 0.014).

Conclusion

Among hospitalized survivors of AMI, the use of ACEIs/ARBs was associated with a lower risk of follow-up HF in patients with LVEF ≤ 40% but not in those with LVEF > 40%. Further prospective studies are needed to confirm our results.

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Authors and Affiliations

  1. Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain

    María Cespón-Fernández, Sergio Raposeiras-Roubín, Emad Abu-Assi, Cristina Barreiro-Pardal, María Castiñeira-Busto, Isabel Muñoz-Pousa, Elena López-Rodríguez, Berenice Caneiro-Queija, Rafael Cobas-Paz, Saleta Fernández-Barbeira, Pablo Domínguez-Erquicia, Luis Manuel Domínguez-Rodríguez, José Antonio Baz-Alonso, Francisco Calvo-Iglesias & Andrés Íñiguez-Romo

  2. Cardiology Department, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain

    Sergio Manzano-Fernández, Pedro Flores-Blanco, Ángel López-Cuenca, Miriam Gómez-Molina & Mariano Valdés-Chávarri

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  1. María Cespón-Fernández
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Corresponding author

Correspondence to María Cespón-Fernández.

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Funding

This study was supported by a clinical research grant from the Spanish Society of Cardiology (Sociedad Española de Cardiología [SEC]).

Conflict of Interest

María Cespón-Fernández, Sergio Raposeiras-Roubín, Emad Abu-Assi, Sergio Manzano-Fernández, Pedro Flores-Blanco, Cristina Barreiro-Pardal, María Castiñeira-Busto, Isabel Muñoz-Pousa, Elena López-Rodríguez, Berenice Caneiro-Queija, Rafael Cobas-Paz, Saleta Fernández-Barbeira, Pablo Domínguez-Erquicia, Luis Manuel Domínguez-Rodríguez, Ángel López-Cuenca, Miriam Gómez-Molina, José Antonio Baz-Alonso, Francisco Calvo-Iglesias, Mariano Valdés-Chávarri, and Andrés Íñiguez-Romo have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Ethical Approval

The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the local ethics committee.

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Cespón-Fernández, M., Raposeiras-Roubín, S., Abu-Assi, E. et al. Renin–Angiotensin System Blockade and Risk of Heart Failure After Myocardial Infarction Based on Left Ventricular Ejection Fraction: A Retrospective Cohort Study. Am J Cardiovasc Drugs 19, 487–495 (2019). https://doi.org/10.1007/s40256-019-00343-7

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