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

Cespón‐Fernández, María; Raposeiras‐Roubín, Sergio; Abu‐Assi, Emad; Pousa, Isabel Muñoz; Queija, Berenice Caneiro; Paz, R J Cobas; Erquicia, Pablo Domínguez; Rodríguez, Leyda; Rodriguez, E Lopez; Busto, M Castineira; Barbeira, S Fernandez; Romo, Andrés Íñiguez

doi:10.1177/0003319720946971

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…Focusing on patients without impaired LVEF, the prognostic role of ACEi and ARB was comprehensively investigated in 3006 patients with acute coronary syndrome and preserved ejection fraction (i.e., LVEF ≥ 40%). A comparable risk of all-cause mortality, as well as similar rates of the composite endpoint (i.e., death, AMI and HF) were demonstrated in patients treated with ACEi as compared to ARB [ 21 ]. These comparable effects may rely on the comparable effect of ACEi and ARB reducing the synthesis of angiotensin II, which represents a cornerstone in the pathogenesis of arrhythmic events on a structural, cellular and electrophysiological level [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Angiotensin Converting Enzyme Inhibitors versus Receptor Blockers in Patients with Ventricular Tachyarrhythmias

Schupp

Behnes

Abumayyaleh

et al. 2022

JCM

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Data investigating the prognostic value of treatment with angiotensin converting enzyme inhibitors (ACEi) and receptor blockers (ARB) usually focusses on patients presenting with heart failure (HF) or acute myocardial infarction (AMI). However, by preventing adverse cardiac remodeling, ACEi/ARB may also decrease the risk of ventricular tachyarrhythmias and sudden cardiac death (SCD). Although ventricular tachyarrhythmias are associated with significant mortality and morbidity, only limited data are available focusing on the prognostic role of ACEi/ARB, when prescribed for secondary prevention of SCD. Therefore, this study comprehensively investigates the role of ACEi versus ARB in patients with ventricular tachyarrhythmias. A large retrospective registry was used including consecutive patients with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. The primary prognostic outcome was all-cause mortality at three years, secondary endpoints comprised a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, ICD therapies and sudden cardiac death) and cardiac rehospitalization. A total of 1236 patients were included (15% treated with ARB and 85% with ACEi) and followed for a median of 4.0 years. At three years, ACEi and ARB were associated with comparable long-term mortality (20% vs. 17%; log rank p = 0.287; HR = 0.965; 95% CI 0.689–1.351; p = 0.835) and comparable risk of the composite arrhythmic endpoint (HR = 1.227; 95% CI 0.841–1.790; p = 0.288). In contrast, ACEi was associated with a decreased risk of cardiac rehospitalization at three years (HR = 0.690; 95% CI 0.490–0.971; p = 0.033). Within the propensity score matched cohort (i.e., 158 patients with ACEi and ARB), ACEi and ARB were associated with comparable long-term outcomes at three years. In conclusion, ACEi and ARB are associated with comparable risk of long-term outcomes in patients presenting with ventricular tachyarrhythmias.

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Section: Discussionmentioning

confidence: 99%

Angiotensin Converting Enzyme Inhibitors versus Receptor Blockers in Patients with Ventricular Tachyarrhythmias

Schupp

Behnes

Abumayyaleh

et al. 2022

JCM

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“…Nevertheless, neither of the above study populations [18][19][20] were restricted to patients with UA.…”

Section: Discussionmentioning

confidence: 99%

“…After PSM, they found that the occurrence of allcause death (HR = 1.113, 95% CI: .986-1.257, P = .084) was not significantly different in the angina group, with a median follow-up of 2.2 years. Nevertheless, neither of the above study populations [24][25][26] were restricted to patients with UA.…”

Section: Discussionmentioning

confidence: 99%

“…Regretfully, this study did not evaluate the effects of ACEI and ARB separately. Cespon et al 25 focused on a ACS population with preserved left ventricular systolic function to assess whether the selection between ACEI and ARB could contribute to differences in long-term prognosis. They found that there were no differences in combined events (all-cause death, AMI and HF) (HR = 1.03, 95% CI: .85–1.24, P = .796), AMI (HR = 1.03, 95% CI: .75–1.43, P = .839) and HF (HR = 1.04, 95% CI: .81–1.34, P = .768) between the ACEI and ARB groups after the follow-up period (median follow-up: 3.6 ± 2.1 years).…”

Section: Discussionmentioning

confidence: 99%

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Comparison Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Unstable Angina with Preserved Left Ventricular Systolic Function

2022

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The present study evaluated the clinical results of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) treatment in patients with unstable angina (UA) with preserved left ventricular systolic function who underwent percutaneous coronary intervention (PCI) due to uncertainty regarding the long-term prognosis using ACEI or ARB. A total of 1627 UA patients with preserved left ventricular systolic function after PCI were enrolled. After propensity score matching, there were no differences in major adverse cardiovascular and cerebrovascular events (MACCEs) (hazard ratio (HR) = .860, 95% confidence interval (CI): .465–1.590, P = .630), all-cause death (HR = .334, 95% CI: .090–1.238, P = .101), nonfatal myocardial infarction (HR = 4.929, 95% CI: .576–42.195, P = .145), stroke (HR = 1.049, 95% CI: .208–5.290, P = .954) and target vessel revascularization (TVR) (HR = 1.276, 95% CI: .537–3.031, P = .581) between the ACEI and ARB groups. In conclusion, prognoses were comparable between ACEI or ARB treatment in UA patients who had preserved left ventricular systolic function after PCI.

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“…ACEI/ARB has been shown to reduce adverse cardiovascular events in patients with HF, MI combined with HF, and high-risk CAD ( 20 – 22 ). In the HOPE study, ramipril significantly reduced the rates of composite endpoints of death from a cardiovascular cause, MI, and stroke in high-risk patients who are not identified as a low LVEF or HF ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Incident Heart Failure in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Yin

et al. 2021

Front. Cardiovasc. Med.

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Background: The contemporary incidence of heart failure (HF) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. This prospective cohort study was designed to study the incidence and predictors of new-onset HF in CAD patients after PCI (ChiCTR1900023033).Methods: From January 2014 to December 2018, 3,910 CAD patients without HF history undergoing PCI were prospectively enrolled. Demographics, medical history, cardiovascular risk factors, cardiac parameters, and medication data were collected at baseline. Multivariable adjusted competing-risk regression analysis was performed to examine the predictors of incident HF.Results: After a median follow-up of 63 months, 497 patients (12.7%) reached the primary endpoint of new-onset HF, of which 179, 110, and 208 patients (36.0, 22.1, and 41.9%) were diagnosed as having HF with reduced ejection fraction (EF) (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF), respectively. Higher B-type natriuretic peptide (BNP) or E/e′ level, lower estimated glomerular filtration rate (eGFR) level, and atrial fibrillation were the independent risk factors of new-onset HF. Gender (male) and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) prescription were the negative predictors of new-onset HF. Moreover, it was indicated that long-term ACEI/ARB therapy, instead of beta-blocker use, was linked to lower risks of development of all three HF subtypes (HFrEF, HFmrEF and HFpEF).Conclusions: This prospective longitudinal cohort study shows that the predominant subtype of HF after PCI is HFpEF and ACEI/ARB therapy is accompanied with reduced risks of incident HF across three subtypes.

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

Cited by 6 publications

References 29 publications

Angiotensin Converting Enzyme Inhibitors versus Receptor Blockers in Patients with Ventricular Tachyarrhythmias

Angiotensin Converting Enzyme Inhibitors versus Receptor Blockers in Patients with Ventricular Tachyarrhythmias

Comparison Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Unstable Angina with Preserved Left Ventricular Systolic Function

Incident Heart Failure in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

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