The study population was selected from the Korean Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) [10 (link)]. KAMIR-NIH is a nation-wide, prospective, multicenter, web-based observational cohort study aiming to develop a prognostic and surveillance index for patients with AMI. Patients who were hospitalized primarily for AMI and signed informed consents were consecutively enrolled from November 2011 to October 2015. This study was conducted according to the ethical guidelines of the Declaration of Helsinki. The study protocol was approved by the ethics committee at Chonnam National University Hospital, Republic of Korea (IRB No. CNUH-2011-172) and the institutional review boards of all participating hospitals approved the study protocol. Written informed consents were obtained from participating patients or legal representative. Data were collected by the attending physician with the assistance of a trained clinical research coordinator, via a web-based case report form in the clinical data management system of the Korea NIH. Patients, who died during index hospitalization, did not have hypertension, were prescribed neither ACEI nor ARB, or both ACEI and ARB at discharge, did not undergo echocardiographic study, and had incomplete clinical data, were excluded.
AMI was diagnosed when there was an evidence of myocardial necrosis (a rise and/or fall in cardiac biomarker, preferably cardiac troponin), and at least one of the following: (1) symptoms of ischemia, (2) new or presumed new significant ST-segment-T wave changes or a new left bundle branch block, (3) a development of pathologic Q waves in the electrocardiogram, (4) an imaging evidence of the new loss of viable myocardium or new regional wall motion abnormality, and (5) the identification of an intracoronary thrombus by angiography [11 (link)]. Hypertension was defined as values ≥140 mmHg of systolic BP (SBP) and/or ≥90 mmHg of diastolic BP (DBP) during the initial hospitalization [12 (link), 13 (link)]. Patients with a history of hypertension or antihypertensive treatment on the interview were also considered to have hypertension. Coronary reperfusion included reperfusion by percutaneous coronary intervention (PCI), thrombolysis, or coronary artery bypass graft (CABG), MI with non-obstructed coronary arteries (MINOCA) [3 (link)], and myocardial bridge. LV systolic function was evaluated by the echocardiographic study during the initial hospitalization.
AMI was diagnosed when there was an evidence of myocardial necrosis (a rise and/or fall in cardiac biomarker, preferably cardiac troponin), and at least one of the following: (1) symptoms of ischemia, (2) new or presumed new significant ST-segment-T wave changes or a new left bundle branch block, (3) a development of pathologic Q waves in the electrocardiogram, (4) an imaging evidence of the new loss of viable myocardium or new regional wall motion abnormality, and (5) the identification of an intracoronary thrombus by angiography [11 (link)]. Hypertension was defined as values ≥140 mmHg of systolic BP (SBP) and/or ≥90 mmHg of diastolic BP (DBP) during the initial hospitalization [12 (link), 13 (link)]. Patients with a history of hypertension or antihypertensive treatment on the interview were also considered to have hypertension. Coronary reperfusion included reperfusion by percutaneous coronary intervention (PCI), thrombolysis, or coronary artery bypass graft (CABG), MI with non-obstructed coronary arteries (MINOCA) [3 (link)], and myocardial bridge. LV systolic function was evaluated by the echocardiographic study during the initial hospitalization.
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