Prognosis after discontinuing renin angiotensin aldosterone system inhibitor for heart failure with restored ejection fraction after acute myocardial infarctionopen access
- Authors
- Lee, S.H.[Lee, S.H.]; Rhee, T.-M.[Rhee, T.-M.]; Shin, D.[Shin, D.]; Hong, D.[Hong, D.]; Choi, K.H.[Choi, K.H.]; Kim, H.K.[Kim, H.K.]; Park, T.K.[Park, T.K.]; Yang, J.H.[Yang, J.H.]; Song, Y.B.[Song, Y.B.]; Hahn, J.-Y.[Hahn, J.-Y.]; Choi, S.-H.[Choi, S.-H.]; Chae, S.C.[Chae, S.C.]; Cho, M.-C.[Cho, M.-C.]; Kim, C.J.[Kim, C.J.]; Kim, J.H.[Kim, J.H.]; Kim, H.-S.[Kim, H.-S.]; Gwon, H.-C.[Gwon, H.-C.]; Jeong, M.H.[Jeong, M.H.]; Lee, J.M.[Lee, J.M.]; Lee, S.H.[Lee, S.H.]; Rhee, T.-M.[Rhee, T.-M.]; Shin, D.[Shin, D.]; Hong, D.[Hong, D.]; Choi, K.H.[Choi, K.H.]; Kim, H.K.[Kim, H.K.]; Park, T.K.[Park, T.K.]; Yang, J.H.[Yang, J.H.]; Song, Y.B.[Song, Y.B.]; Hahn, J.-Y.[Hahn, J.-Y.]; Choi, S.-H.[Choi, S.-H.]; Chae, S.C.[Chae, S.C.]; Cho, M.-C.[Cho, M.-C.]; Kim, C.J.[Kim, C.J.]; Kim, J.H.[Kim, J.H.]; Kim, H.-S.[Kim, H.-S.]; Gwon, H.-C.[Gwon, H.-C.]; Jeong, M.H.[Jeong, M.H.]; Lee, J.M.[Lee, J.M.]; The KAMIR-NIH Investigators[The KAMIR-NIH Investigators]
- Issue Date
- 2-Mar-2023
- Publisher
- Nature Research
- Citation
- Scientific Reports, v.13, no.1
- Indexed
- SCIE
SCOPUS
- Journal Title
- Scientific Reports
- Volume
- 13
- Number
- 1
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/103917
- DOI
- 10.1038/s41598-023-30700-1
- ISSN
- 2045-2322
- Abstract
- Prognostic effect of discontinuing renin–angiotensin–aldosterone-system-inhibitor (RAASi) for patients with heart failure (HF) after acute myocardial infarction (AMI) whose left ventricular (LV) systolic function was restored during follow-up is unknown. To investigate the outcome after discontinuing RAASi in post-AMI HF patients with restored LV ejection fraction (EF). Of 13,104 consecutive patients from the nationwide, multicenter, and prospective Korea Acute Myocardial Infarction-National Institutes of Health (KAMIR-NIH) registry, HF patients with baseline LVEF < 50% that was restored to ≥ 50% at 12-month follow-up were selected. Primary outcome was a composite of all-cause death, spontaneous MI, or rehospitalization for HF at 36-month after index procedure. Of 726 post-AMI HF patients with restored LVEF, 544 maintained RAASi (Maintain-RAASi) beyond 12-month, 108 stopped RAASi (Stop-RAASi), and 74 did not use RAASi (RAASi-Not-Used) at baseline and follow-up. Systemic hemodynamics and cardiac workloads were similar among groups at baseline and during follow-up. Stop-RAASi group showed elevated NT-proBNP than Maintain-RAASi group at 36-month. Stop-RAASi group showed significantly higher risk of primary outcome than Maintain-RAASi group (11.4% vs. 5.4%; adjusted hazard ratio [HRadjust] 2.20, 95% confidence interval [CI] 1.09–4.46, P = 0.028), mainly driven by increased risk of all-cause death. The rate of primary outcome was similar between Stop-RAASi and RAASi-Not-Used group (11.4% vs. 12.1%; HRadjust 1.18 [0.47–2.99], P = 0.725). In post-AMI HF patients with restored LV systolic function, RAASi discontinuation was associated with significantly increased risk of all-cause death, MI, or rehospitalization for HF. Maintaining RAASi will be necessary for post-AMI HF patients, even after LVEF is restored. © 2023, The Author(s).
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