Impact of renin-angiotensin system blockade on the prognosis of acute coronary syndrome based on left ventricular ejection fraction.
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Raposeiras-Roubín Sergio, Abu-Assi Emad, Cespón-Fernández María, Ibáñez Borja, García-Ruiz José Manuel, D'Ascenzo Fabrizio, Simao Henriques Jose Paulo, Saucedo Jorge, Caneiro-Queija Berenice, Cobas-Paz Rafael, Muñoz-Pousa Isabel, Wilton Stephen B, González Juanatey José Ramón, Kikkert Wouter J, Núñez-Gil Iván, Ariza-Solé Albert, Song Xiantao, Alexopoulos Dimitrios, Liebetrau Christoph, Kawaji Tetsuma, Gaita Fiorenzo, Huczek Zenon, Nie Shao-Ping, Yan Yan, Fujii Toshiharu, Correia Luis, Kawashiri Masa-Aki, Kedev Sasko, Southern Danielle, Alfonso Emilio, Terol Belén, Garay Alberto, Zhang Dongfeng, Chen Yalei, Xanthopoulou Ioanna, Osman Neriman, Möllmann Helge, Shiomi Hiroki, Giordana Francesca, Kowara Michal, Filipiak Krzysztof, Wang Xiao, Fan Jing-Yao, Ikari Yuji, Nakahayshi Takuya, Sakata Kenji, Yamagishi Masakazu, Kalpak Oliver, Íñiguez-Romo Andrés
Аннотация
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.