Impact of renin-angiotensin system blockade on the prognosis of acute coronary syndrome based on left ventricular ejection fraction.

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. 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. 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). 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.

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 ，Íñiguez-Romo A ... -  《-》

Angiotensin-Converting Enzyme Inhibitors Versus Angiotensin II Receptor Blockers in Acute Coronary Syndrome and Preserved Ventricular Ejection Fraction.

Cespón-Fernández M ，Raposeiras-Roubín S ，Abu-Assi E ，Pousa IM ，Queija BC ，Paz RJC ，Erquicia PD ，Rodríguez LMD ，Rodríguez EL ，Busto MC ，Barbeira SF ，Romo AÍ ... -  《-》

Renin-Angiotensin System Antagonists in Patients Without Left Ventricular Dysfunction After Percutaneous Intervention for ST-Segment Elevation Myocardial Infarction.

There is a paucity of evidence on the impact of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on long-term outcomes in patients with ejection fraction (EF) >40% after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). We compared long-term all-cause mortality between patients with left ventricular ejection fraction (LVEF) >40% discharged on ACEi/ARB with patients who were discharged on neither of these agents. Patients discharged after percutaneous intervention for STEMI from our catheterization laboratories from January 2002 to December 2011 were considered for inclusion. Patients were excluded if they had LVEF <40% or chronic kidney disease or hypotension (systolic blood pressure <90 mm Hg any time after the procedure). Long-term mortality and discharge medications were determined using the Social Security Death Index and electronic medical record review, respectively. A total of 988 patients were included. The median follow-up duration was 4.6 years. Kaplan-Meier analysis showed no significant difference in long-term all-cause mortality in patients discharged on ACEi/ARB compared with those who were not discharged on these medications. The number needed to treat to prevent 1 death at 1 year was 714. In addition, multivariable Cox proportional hazard modeling failed to demonstrate any beneficial effect of ACEi/ARB similar to Kaplan-Meir analysis (hazard ratio 0.88, 95% confidence interval 0.57 to 1.36). In conclusion, we found no significant benefit in long-term mortality using ACEi/ARB in patients with LVEF >40% after primary percutaneous coronary intervention for STEMI.

Parashar A ，Agarwal S ，Krishnaswamy A ，Garg A ，Poddar KL ，Sud K ，Ellis S ，Tuzcu EM ，Kapadia SR ... -  《-》

Renin-Angiotensin System Blockade and Risk of Heart Failure After Myocardial Infarction Based on Left Ventricular Ejection Fraction: A Retrospective Cohort Study.

Cespón-Fernández M ，Raposeiras-Roubín S ，Abu-Assi E ，Manzano-Fernández S ，Flores-Blanco P ，Barreiro-Pardal C ，Castiñeira-Busto M ，Muñoz-Pousa I ，López-Rodríguez E ，Caneiro-Queija B ，Cobas-Paz R ，Fernández-Barbeira S ，Domínguez-Erquicia P ，Domínguez-Rodríguez LM ，López-Cuenca Á ，Gómez-Molina M ，Baz-Alonso JA ，Calvo-Iglesias F ，Valdés-Chávarri M ，Íñiguez-Romo A ... -  《-》

Mortality benefit of long-term angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after successful percutaneous coronary intervention in non-ST elevation acute myocardial infarction.

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to reduce mortality after myocardial infarction (MI). Current guidelines recommend their prescription in all patients after MI. Limited data are available on whether ACEIs/ARBs still improve prognosis in the contemporary era of non-ST elevation MI (NSTEMI) management. We aimed to evaluate the mortality benefit of ACEIs/ARBs in NSTEMI patients treated successfully with percutaneous coronary intervention (PCI). We analyzed 2784 patients with NSTEMI treated successfully with in-hospital PCI. Two groups were formed based on ACEI/ARB prescription at discharge. Two propensity score (PS) analyses were performed to control for differences in covariates: one with adjustment among the entire cohort, and the other with PS matching (n=1626). The outcome variable was all-cause mortality at four-year follow-up. There were 1902 (68.3%) patients prescribed ACEIs/ARBs at discharge. When adjusted by PS, ACEI/ARB use was associated with a hazard ratio (HR) for mortality of 0.75 (0.60-0.94; absolute risk reduction [ARR] 4.0%) in the whole cohort (p=0.01). After one-to-one PS matching (n=813 in each group), the mortality rate was significantly lower in patients prescribed ACEIs/ARBs, with HR of 0.77 (0.63-0.94; ARR 3.8%) (p=0.03). In this observational study of patients with NSTEMI, all of them treated successfully by PCI, the use of ACEIs/ARBs was significantly associated with a lower risk of four-year all-cause mortality.

González-Cambeiro MC ，López-López A ，Abu-Assi E ，Raposeiras-Roubín S ，Peña-Gil C ，García-Acuña J ，González-Juanatey R ... -  《-》