Original ArticleAngiotensin-Converting Enzyme Inhibitor–based Versus Angiotensin Receptor Blocker–based Optimal Medical Therapy After Percutaneous Coronary Intervention: A Nationwide Cohort StudyPark, Sangwoo MD*; Kim, Yong-Giun MD, PhD*; Ann, Soe Hee MD, PhD*; Park, Hyun Woo MD†; Suh, Jon MD, PhD†; Roh, Jae-Hyung MD, PhD‡; Cho, Young-Rak MD, PhD§; Han, Seungbong PhD¶; Park, Gyung-Min MD, PhD*Author Information *Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; †Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon, Republic of Korea; ‡Department of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea; §Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea; and ¶Department of Applied Statistics, Gachon University, Seongnam, Republic of Korea. Reprints: Gyung-Min Park, MD, PhD, Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, Korea 44033 (e-mail: [email protected]) or Seungbong Han, PhD, Department of Applied Statistics, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, Gyeonggi-do, Korea 13120 (e-mail: [email protected]). Supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education [2018R1D1A3B07043344] and the Ministry of Science, ICT [2017R1C1B1006717]. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcvp.org). Data availability: This study analyzed the National Health Insurance (NHI) claims data in South Korea. Data of the NHI claims are accessible to researchers after the permission of the Health Insurance Review and Assessment Service (HIRA) in South Korea. Qualified, interested researchers may request access to these data from the HIRA (http://opendata.hira.or.kr/home.do). Journal of Cardiovascular Pharmacology: January 2021 - Volume 77 - Issue 1 - p 61-68 doi: 10.1097/FJC.0000000000000930 Buy SDC Metrics Abstract Optimal medical therapy (OMT) plays a crucial role in the secondary prevention of established coronary artery disease. The renin–angiotensin system (RAS) is an important target of OMT. However, there is limited evidence on whether there is any difference in the combined effect of OMT according to the classes of RAS blockade [angiotensin-converting enzyme inhibitor (ACEI) vs. angiotensin receptor blocker (ARB)]. Based on the nationwide National Health Insurance database in South Korea, 39,096 patients who received OMT after percutaneous coronary intervention between July 2013 and June 2017 were enrolled. Patients were stratified into either acute myocardial infarction (AMI) or angina cohort and analyzed according to the class of RAS blockade included in OMT at discharge (ACEI vs. ARB). The primary end point was all-cause mortality. The study population had a median follow-up of 2.3 years (interquartile range, 1.3–3.3 years). In the propensity score-matched AMI cohort (8219 pairs), the risk for all-cause mortality was significantly lower in patients with ACEI-based OMT than in those with ARB-based OMT (hazard ratio 0.83 of ACEI, 95% confidence interval 0.73–0.94, P = 0.003). However, in the propensity score-matched angina cohort (6693 pairs), the mortality risk was comparable, regardless of the class of RAS blockade (hazard ratio 1.13, 95 confidence interval 0.99–1.29, P = 0.08). In conclusion, in this nationwide cohort study involving patients receiving OMT after percutaneous coronary intervention, ACEI-based OMT was associated with a significantly lower risk of all-cause mortality in patients with AMI in comparison with ARB, but not in those with angina. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.