Effect of renin-angiotensin system inhibitors on long-term survival in patients treated with beta blockers and antiplatelet agents after acute myocardial infarction (from the MONICA/KORA Myocardial Infarction Registry).

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have shown to decrease mortality and cardiovascular morbidity especially in high-risk patients after acute myocardial infarction (AMI). Aim of this study was to assess the association between ACEI or ARB treatment (ACEI/ARB) at hospital discharge and long-term survival after AMI in real-life patient care. From a German population-based AMI registry, 3,544 patients (75.4% men), aged 28 to 74 years, hospitalized with an incident AMI between 2000 and 2008, surviving at least 24 hours and treated with β blockers and antiplatelet agents at discharge were included in this study. All data were collected by standardized interviews and chart review. End point of this study was all-cause mortality at 3 follow-up periods: 1, 3, and 5 years after AMI. Mortality was assessed for all registered patients in 2010. Survival analyses and multivariable Cox regression analyses were conducted. Of the 3,544 patients, 83.7% received ACEI/ARB and 90.1% were treated with statins at hospital discharge. During a median follow-up period of 5.0 years (interquartile range 1.0 years), 9.3% patients died. In the multivariable Cox models adjusting for a number of covariates, use of ACEI/ARB showed a significantly inverse relation with 1-, 3-, and 5-year mortality (e.g., 5-year mortality: hazard ratio 0.74, 95% confidence interval 0.59 to 0.94, p = 0.015), and the hazard ratios for mortality did not differ significantly between the 3 examined follow-up periods. In conclusion, use of ACEI/ARB at hospital discharge is independently associated with long-term survival benefit in patients with incident AMI already treated with other guideline-recommended cardiovascular drugs.