Abstract：
OBJECTIVE: This study evaluates the 3-year clinical outcomes of high Killip grade (III/IV) acute myocardial infarction (AMI) patients treated with either β-blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI) or BB and angiotensin receptor blockers (ARB).
METHODS: A total of 13,105 patients were registered at the Korea Acute Myocardial Infarction Registry at the National Institute of Health (KAMIR-NIH). Among them, 871 patients with high Killip classification AMI were divided into the BB + ACEI group (n = 489) and the BB + ARB group (n = 381). Following propensity score matching, 343 patients were selected in each group. All patients completed a 3-year follow-up period.
RESULTS: The results indicate no significant differences between the BB + ACEI group and BB + ARB group in terms of cardiac death, recurrent myocardial infarction, and the rate of repeat percutaneous coronary intervention. However, the BB + ACEI group exhibited significantly lower risks in major adverse cardiac events (HR = 0.574, 95% CI: 0.421-0.783, p < .001), all-cause mortality (HR = 0.561, 95% CI: 0.404-0.778, p = .001), and non-cardiac death (HR = 0.365, 95% CI: 0.208-0.639, p < .001) compared to the BB + ARB group.
CONCLUSIONS: Our results suggest that BB + ACEI treatment is more beneficial than BB + ARB for high Killip grade AMI patients. Additionally, the BB + ACEI group has a superior preventative effect on mortality compared to the BB + ARB group.
METHODS: A total of 13,105 patients were registered at the Korea Acute Myocardial Infarction Registry at the National Institute of Health (KAMIR-NIH). Among them, 871 patients with high Killip classification AMI were divided into the BB + ACEI group (n = 489) and the BB + ARB group (n = 381). Following propensity score matching, 343 patients were selected in each group. All patients completed a 3-year follow-up period.
RESULTS: The results indicate no significant differences between the BB + ACEI group and BB + ARB group in terms of cardiac death, recurrent myocardial infarction, and the rate of repeat percutaneous coronary intervention. However, the BB + ACEI group exhibited significantly lower risks in major adverse cardiac events (HR = 0.574, 95% CI: 0.421-0.783, p < .001), all-cause mortality (HR = 0.561, 95% CI: 0.404-0.778, p = .001), and non-cardiac death (HR = 0.365, 95% CI: 0.208-0.639, p < .001) compared to the BB + ARB group.
CONCLUSIONS: Our results suggest that BB + ACEI treatment is more beneficial than BB + ARB for high Killip grade AMI patients. Additionally, the BB + ACEI group has a superior preventative effect on mortality compared to the BB + ARB group.
摘要：
目的：本研究评估了接受β受体阻滞剂（BB）和血管紧张素转换酶抑制剂（ACEI）或BB和血管紧张素受体阻滞剂（ARB）治疗的高Killip级（III/IV）急性心肌梗死（AMI）患者的3年临床结局。
方法：共有13,105名患者在国立卫生研究院（KAMIR-NIH）的韩国急性心肌梗死登记处登记。其中,将871例高Killip分级AMI患者分为BB+ACEI组(n=489)和BB+ARB组(n=381)。在倾向得分匹配之后，每组抽取343例患者。所有患者均完成3年随访。
结果：结果表明BB+ACEI组和BB+ARB组在心源性死亡方面没有显著差异，复发性心肌梗死,和重复经皮冠状动脉介入治疗的比率。然而,BB+ACEI组主要不良心脏事件的风险显著降低(HR=0.574,95%CI:0.421-0.783,p<.001),全因死亡率（HR=0.561，95%CI：0.404-0.778，p=.001），与BB+ARB组相比，非心源性死亡（HR=0.365，95%CI：0.208-0.639，p<.001）。
结论：我们的结果表明，对于高Killip级AMI患者，BB+ACEI治疗比BB+ARB更有益。此外,与BB+ARB组相比，BB+ACEI组对死亡率具有更好的预防作用。
方法：共有13,105名患者在国立卫生研究院（KAMIR-NIH）的韩国急性心肌梗死登记处登记。其中,将871例高Killip分级AMI患者分为BB+ACEI组(n=489)和BB+ARB组(n=381)。在倾向得分匹配之后，每组抽取343例患者。所有患者均完成3年随访。
结果：结果表明BB+ACEI组和BB+ARB组在心源性死亡方面没有显著差异，复发性心肌梗死,和重复经皮冠状动脉介入治疗的比率。然而,BB+ACEI组主要不良心脏事件的风险显著降低(HR=0.574,95%CI:0.421-0.783,p<.001),全因死亡率（HR=0.561，95%CI：0.404-0.778，p=.001），与BB+ARB组相比，非心源性死亡（HR=0.365，95%CI：0.208-0.639，p<.001）。
结论：我们的结果表明，对于高Killip级AMI患者，BB+ACEI治疗比BB+ARB更有益。此外,与BB+ARB组相比，BB+ACEI组对死亡率具有更好的预防作用。
