Impact of in-hospital ACEI use on long-term prognosis in discharged type 2 myocardial infarction patients: a retrospective propensity score-matched cohort study.

objectiveThis study aimed to investigate the association between angiotensin-converting enzyme inhibitor (ACEI) use during hospitalization and short- and long-term prognosis in patients with type 2 myocardial infarction (T2MI) after discharge.

methodsWe conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The analysis included adult critically ill patients diagnosed with T2MI. Exposure was defined as ACEI administration during the intensive care unit (ICU) stay. The primary outcome was 3-year all-cause mortality. Propensity score matching (PSM) was performed at a 1:1 ratio, and matching quality was assessed using standardized mean differences (SMD); all absolute SMD values for matched covariates were below 0.1. Multivariate analysis was used to adjust for potential confounders.

resultsA total of 1,086 T2MI patients were included. After PSM, 590 patients (295 per group) were analyzed. ACEI use was associated with significantly lower 3-year all-cause mortality (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.41–0.74; P < 0.001). Sensitivity analysis further supported this association (HR, 0.58; 95% CI, 0.42–0.80; P < 0.001). Additionally, multivariate Cox analysis indicated that ACEI use was associated with reduced risk of 180-day all-cause mortality (HR, 0.49; 95% CI, 0.33–0.72; P < 0.001). However, no significant associations were observed between ACEI use and 3-year all-cause readmission (HR, 1.003; 95% CI, 0.776–1.295; P = 0.984) or 3-year T2MI recurrence (HR, 1.14; 95% CI, 0.64–2.05; P = 0.654).

conclusionIn this observational study, ACEI use during hospitalization was associated with significantly lower short- and long-term all-cause mortality in patients discharged after T2MI, but was not significantly associated with readmission or T2MI recurrence rates. These findings suggest a potential clinical relevance of ACEIs in T2MI populations and may expand the understanding of their role in myocardial infarction with different pathogenesis. Further prospective studies are warranted to clarify optimal ACEI administration strategies in this patient group. CLINICAL TRIAL NUMBER: Not applicable. KEY QUESTION: Does ACEI use during hospitalization affect the long-term prognosis of T2MI patients after discharge? KEY FINDING: In discharged T2MI patients, the use of ACEI was associated with significantly lower 3-year and 180-day all-cause mortality, but was not associated with a 3-year all-cause readmission or risk of T2MI recurrence. TAKE HOME MESSAGE: The use of ACEI was associated with a significant lower short- and long-term all-cause mortality in patients with discharged T2MI; nevertheless, it does not affect readmission or T2MI recurrence rates. These findings broaden the clinical use of ACEI to include patients with myocardial infarction caused by different pathophysiological mechanisms.