![\"bmj\"](\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2014\/11\/bmj-282x300.png\")
<\/a><\/p>\nMedian followup of 371 days. This study involved propensity scoring, a technique\u00a0used in nonrandomized trials to mathematically compensate for covariates that could have influenced treatment allocation (in this case, adjusting for differences in clinical, angiographic and procedural characteristics of the groups).<\/p>\n
Results:<\/strong><\/p>\n –In comparing the groups: those on ARBs (vs ACE-I)\u00a0were older, had higher creatinine levels, had more LAD artery lesions in the area of infarct, though had lower prevalence of smoking. those in the “neither” group tended to have a higher risk profile at the time of the PCI<\/p>\n –Cardiac death or myocardial infarction occurred in\u00a021 patients on ARBs (1.8%), 77 patients on ACE-I (1.7%), but in 33 on neither (3.5%).<\/p>\n –By propensity matching (1175 pairs), no significant difference between ARBs and ACE-I, with those endpoints in\u00a01.8% in ARB group and 2.0% in ACE-Igroup. Propensity matching (803 pairs) between the ARB group and the neither group found the ARB group had 1.7% and the neither group 3.1%,\u00a0a significant difference (p=0.03)<\/p>\n So, not a randomized controlled trial, but a large trial doing mathematical modeling to try to compensate for underlying potential differences in patients assigned to one of the 3 groups (ARB vs ACE-I\u00a0vs neither), finding essentially no difference in the hard outcomes of cardiac death or MI between ABR or ACE-I, and that either was\u00a0much better than neither. There were unanswered questions in this registry cohort, such as the relatively short followup time of 1 year, the\u00a0dose of meds taken, why patients were assigned to the different groups, and ultimately\u00a0the numbers of events was pretty small, limiting the statistical power. But, overall\u00a0this study validates what probably most of us were doing anyway: try an ACE-I, using ARBs with patients who are ACE-intolerant.<\/p>\n Geoff<\/p>\n","protected":false},"excerpt":{"rendered":" Angiotensin receptor blockers after ST-elevated MI […]<\/p>\n