Effect of angiotensin converting enzyme inhibitors on periprocedural myocardial infarction in patients with metabolic syndrome

Abstract

Background: Metabolic syndrome (MetS) has been reported as a risk factor for cardiovascular events. The aim of the present study is to investigate the association between chronic angiotensin-converting enzyme inhibitors (ACE-I) therapy and the rate of periprocedural myocardial infarction (PMI) after elective coronary stenting among patients with MetS. Methods: The inclusion criteria were MetS and plan for elective percutaneous coronary intervention. To assess the effect of ACE-I treatment on the incidence of PMI, measurements of cardiac biomarkers (CK-MB mass and troponin I) were performed at baseline and 24 h after the procedure. Results: A total of 459 patients fulfilling the inclusion criteria were recruited to chronic ACE-I treatment and ACE-I naive groups in a 2/1 ratio. Baseline troponin I and CK-MB levels were similar in both treatment groups, whereas they were significantly lower in ACE-I group 24 h after the procedure. Univariate analysis identified body mass index (BMI), LDL cholesterol, nitrate and ACE-I use as significant factors for the development of PMI. Multivariate regression model revealed that body mass index increased and use of nitrate and ACE-I decreased the probability of PMI independent from confounding factors (OR 1.14, p = 0.002 for BMI; OR 0.26, p = 0.01 for nitrate use, OR 0.51,. Conclusions:This prospective observational cohort trial demonstrated that chronic ACE-I therapy was an independent predictor for reduced PMI among patients with MetS who underwent elective coronary intervention. (Cardiol J 2015; 22, 3: 323-329)

Efficacy of Ace Inhibition with Zofenopril, Lisinopril, or Ramipril in Postacute Myocardial Infarction Patients With or Without Metabolic Syndrome: A Pooled Individual Data Analysis of Four Randomized, Double-Blind, Controlled, Prospective Studies

“…Recently, one prospective, although observational study, showed that chronic ACE inhibition therapy of MS+ patients can reduce the risk of periprocedural myocardial infarction compared with the ACE inhibitor naive group. 19 All these findings taken together strengthen the recommendations of current guidelines, which indicate that ACE inhibitors and angiotensin II-AT1 receptor blockers as the preferred treatment for high-risk patients. 20 , 21 …”