Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers Are Associated With Improved Outcome but do Not Prevent New-Onset Atrial Fibrillation After Acute Myocardial Infarction

Background-treatment with renin-angiotensin system (ras) inhibitors might restrain the structural/electrical remodeling associated with atrial fibrillation (af). limited evidence exists regarding the potential benefits of ras inhibition post-acute myocardial infarction (ami) in patients with af. this study sought to assess the association between ras inhibition and all-cause mortality and new-onset af in patients with/without congestive heart failure (chf) post-ami. methods and results--patients hospitalized for ami between 2006 and 2012 were identified in swedish registries. patients were stratified in 4 subgroups; patients with chf and af (n=11 489); patients with chf without af (n=31 676); patients with af without chf (n=10 066); and patients without both chf and af (n=59 417). patients exposed to ras inhibition were compared to nontreated. three-year risk of all-cause mortality and new-onset af was assessed using adjusted cox regression analyses. at discharge,83 291 (73.9%) patients received ras inhibition. ras inhibition was associated with lower 3-year risk of all-cause mortality in chf patients with af,adjusted hazard ratio (hr) with 95% ci 0.75 (0.70-0.81),chf patients without af,hr 0.65 (0.60-0.69),af patients without chf,hr 0.82 (0.75-0.90),and in patients without chf and af,hr 0.76 (0.72-0.81),respectively. ras inhibition was not associated with lower 3-year risk of new-onset af in patients without af but with/without chf; hr 0.96 (0.84-1.10) and 1.12 (1.02-1.22),respectively. conclusions--ras inhibition post-ami was associated with lower risk of all-cause mortality. in patients with/without chf,ras inhibition was not associated with lower incidence of new-onset af. © 2017 the authors.