1. Impact of renin-angiotensin system blockade on the prognosis of acute coronary syndrome based on left ventricular ejection fraction.
- Author
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Raposeiras-Roubín S, Abu-Assi E, Cespón-Fernández M, Ibáñez B, García-Ruiz JM, D'Ascenzo F, Simao Henriques JP, Saucedo J, Caneiro-Queija B, Cobas-Paz R, Muñoz-Pousa I, Wilton SB, González Juanatey JR, Kikkert WJ, Núñez-Gil I, Ariza-Solé A, Song X, Alexopoulos D, Liebetrau C, Kawaji T, Gaita F, Huczek Z, Nie SP, Yan Y, Fujii T, Correia L, Kawashiri MA, Kedev S, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Kowara M, Filipiak K, Wang X, Fan JY, Ikari Y, Nakahayshi T, Sakata K, Yamagishi M, Kalpak O, and Íñiguez-Romo A
- Subjects
- Acute Coronary Syndrome mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Propensity Score, Registries, Retrospective Studies, Treatment Outcome, Acute Coronary Syndrome therapy, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Percutaneous Coronary Intervention methods, Renin-Angiotensin System drug effects, Stroke Volume physiology, Ventricular Function, Left physiology
- Abstract
Introduction and Objectives: For patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI), it is unclear whether angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are associated with reduced mortality, particularly with preserved left ventricular ejection fraction (LVEF). The goal of this study was to determine the association between ACEI/ARB and mortality in ACS patients undergoing PCI, with and without reduced LVEF., Methods: Data from the BleeMACS registry were used. The endpoint was 1-year all-cause mortality. The prognostic value of ACEI/ARB was tested after weighting by survival-time inverse probability and after adjustment by Cox regression, propensity score, and instrumental variable analysis., Results: Among 15 401 ACS patients who underwent PCI, ACEI/ARB were prescribed in 75.2%. There were 569 deaths (3.7%) during the first year after hospital discharge. After multivariable adjustment, ACEI/ARB were associated with lower 1-year mortality, ≤ 40% (HR, 0.62; 95%CI, 0.43-0.90; P=.012). The relative risk reduction of ACEI/ARB in mortality was 46.1% in patients with LVEF ≤ 40%, and 15.7% in patients with LVEF> 40% (P value for treatment-by-LVEF interaction=.008). For patients with LVEF> 40%, ACEI/ARB was associated with lower mortality only in ST-segment elevation myocardial infarction (HR, 0.44; 95%CI, 0.21-0.93; P=.031)., Conclusion: The benefit of ACEI/ARB in decreasing mortality after an ACS in patients undergoing PCI is concentrated in patients with LVEF ≤ 40%, and in those with LVEF> 40% and ST-segment elevation myocardial infarction. In non-ST-segment elevation-ACS patients with LVEF> 40%, further studies are needed to assess the prognostic impact of ACEI/ARB., (Copyright © 2019. Published by Elsevier España, S.L.U.)
- Published
- 2020
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