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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.

journal of the american heart association

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