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

Raposeiras‐Roubín, Sergio; Abu‐Assi, Emad; Cespón‐Fernández, María; Ibáñez, Borja; García-Ruiz, José M.; D’Ascenzo, Fabrizio; Henriques, José P.S.; Saucedo, Jorge; Caneiro‐Queija, Berenice; Paz, Rafael Cobas; Muñoz-Pousa, Isabel; Wilton, Stephen B.; González-Juanatey, José Ramón; Kikkert, Wouter J.; Núñez‐Gil, Iván J.; Arizá-Solé, Albert; Song, Xiantao; Alexopoulos, Dimitrios; Liebetrau, Christoph; Kawaji, Tetsuma; Gaïta, Fiorenzo; Huczek, Zenon; Nie, Shaoping; Yan, Yan; Fujii, Toshiharu; Correia, Luis; Kawashiri, Masa‐aki; Kedev, Saško; Southern, Danielle; Alfonso, Emilio; Terol, Belén; Garay, Alberto; Zhang, Dongfeng; Chen, Yalei; Xanthopoulou, Ioanna; Osman, Neriman; Möllmann, Helge; Shiomi, Hiroki; Giordana, Francesca; Kowara, Michał; Filipiak‬, Krzysztof J.; Xiao, Wang; Fan, Jingyao; Ikari, Yuji; Nakahayshi, Takuya; Sakata, Kenji; Yamagishi, Masakazu; Kalpak, Oliver; Íñiguez‐Romo, Andrés

doi:10.1016/j.rec.2019.02.012

Cited by 9 publications

(14 citation statements)

References 27 publications

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“…However, most of the evidence supporting these recommendations comes from studies of patients with substantially impaired cardiac function (i.e., ejection fraction [EF] < 35–40%) who were not treated by modernized secondary preventive measures, including percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT), and lipid-lowering medications ( Pfeffer et al, 1992 ; Yusuf et al, 1992 ; Ball et al, 1993 ; Rutherford et al, 1994 ). Accumulating evidence shows that ACEI/ARB is not effective for reducing mortality in ACS patients with a baseline EF > 40%, casting doubts on whether these agents should be routinely used as one of the long-term medications in every patient after the index coronary event ( Parashar et al, 2015 ; Bangalore et al, 2017 ; Park et al, 2018 ; Cespón-Fernández et al, 2019 ; Raposeiras-Roubín et al, 2020 ). Meanwhile, over half of the patients acquire generally normal cardiac function with standard care after ACS, which could possibly attenuate the clinical significance for the blockade of renin-angiotensin system (RAS) with ACEI/ARB medications ( Sutton et al, 2016 ; Chen et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impacts of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Coronary Syndrome Patients Without Heart Failure

et al. 2022

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Background: Despite the recommendations from mainstream guidelines, the use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) for acute coronary syndrome (ACS) patients without heart failure (HF) is controversial, as its evidence is lacking in the era of reperfusion and intensive secondary preventions. This study aimed to investigate the impacts of ACEI/ARB on outcomes of ACS patients without HF treated by percutaneous coronary intervention (PCI).Methods: A total of 2,397 non-HF ACS patients treated by PCI were retrospectively recruited. Prognostic impacts of ACEI/ARB were assessed by unadjusted analysis, followed by propensity score matching (PSM) and propensity score matching weight (PSMW) analysis to control the between-group differences. The primary outcome was a composite of all-cause death and recurrent myocardial infarction (MI).Results: Among the included patients, 1,805 (75.3%) were prescribed with ACEI/ARB at discharge. The median follow-up time was 727 (433–2016) days, with 129 (5.4%) primary endpoint events, consisting of 55 (2.3%) cases of all-cause death and 74 (3.1%) cases of recurrent MI. The use of ACEI/ARB was not associated with significant risk reduction of primary endpoint events in unadjusted analysis (hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.64–1.39, p = 0.779), PSM analysis (HR: 0.94, 95% CI: 0.60–1.47, p = 0.784), and PSMW analysis (HR: 0.91, 95% CI: 0.55–1.49, p = 0.704). Similar results were observed for secondary outcomes of all-cause death, cardiac death, and recurrent MI.Conclusion: For ACS patients without HF, the use of ACEI/ARB was not associated with lower risk of death or recurrent MI after PCI.

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Section: Introductionmentioning

confidence: 99%

Prognostic Impacts of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Coronary Syndrome Patients Without Heart Failure

et al. 2022

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“…It was observed that while the benefit is clear for patients with depressed LVEF, there are only some subgroups of patients with preserved LVEF that would benefit from the use of angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II receptor blockers (ARB; essentially, those with ST-elevation myocardial infarction [STEMI]). 6,7 International clinical practice guidelines for the management of ACS establish ACEi as a drug of first choice over ARB for treating all ACS patients in the absence of contraindications. 8,9 Those guidelines propose the use of ARB as an alternative for patients who are intolerant to ACEi without setting any efficacy criteria between both therapies (ACEi vs ARB).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II receptor blockers (ARB) showed comparable survival results in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, there is lack of evidence of the comparative effectiveness in preserved LVEF patients after an acute coronary syndrome (ACS). The aim of this study was to evaluate whether the selection between ACEi and ARB in preserved LVEF after an ACS confers a prognostic benefit, based on real life results. We analyzed a cohort of 3006 contemporary patients with LVEF ≥40% after an ACS. A propensity score matching and Cox regression analysis were performed to assess the association between treatment and events (death, acute myocardial infarction [AMI], HF, and combined event) for a mean follow-up of 3.6 ± 2.1 years. We found no significant differences between ACEi/ARB for all-cause mortality (hazard ratio [HR] for ARB: 0.95, 95% CI: 0.70-1.29), AMI (HR for ARB: 1.34, 95% CI: 0.95-1.89), HF (HR for ARB: 1.11, 95% CI: 0.85-1.45), or combined end point (death, AMI and HF: HR for ARB: 1.14, 95% CI: 0.92-1.40). In conclusion, there are no prognostic differences between the use of ACEi and ARB in patients with LVEF ≥40% after ACS. Further prospective studies are needed to confirm our results.

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“…Com isso, é proposto que tal padrão de consumo anteceda um período de abstinência que pode ser de curto ou longo período (horas, dias ou um mês). Portanto, é justificável que o período da abstinência impeça o desenvolvimento do estresse oxidativo sistêmico e/ou tecidual transitório, permitindo assim o restabelecimento do equilíbrio redox celular, com ressalva de que esse padrão de consumo também apresenta alterações moleculares, sendo responsável por efeitos, como a rigidez arterial (HWANG et al, 2020) que à longo prazo pode promover o desenvolvimento de doenças semelhantes à exposição crônica do etanol, como a hipertensão arterial (RAPOSEIRAS-ROUBÍN et al, 2020).…”

Section: Introductionunclassified

“…As principais ações fisiológicas da ANG II são mediadas pelos receptores AT 1 e incluem contração vascular, secreção de aldosterona, reabsorção de sódio tubular e ativação do sistema autônomo simpático (TOUYZ eSCHIFFRIN, 2000). Contudo, é importante frisar que o SRA pode ser encontrado em outros tecidos, além da suprarrenal, como em hipocampo do sistema nervoso e no ventrículo esquerdo do sistema cardiovascular, complementando a ação endócrina desse sistema envolvidos no mecanismo de doenças como a hipertensão arterial, por exemplo(NAKAGAWA et al, 2020;RAPOSEIRAS-ROUBÍN et al, 2020).…”

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Efeito do consumo de etanol em padrão binge sobre o estresse oxidativo sistêmico

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Intermittent consumption of ethanol, called binge drinking, is related to damage to the individual's health. Binge drinking describes the pattern of consuming alcoholic beverages that results in blood ethanol concentration equal to or greater than 0.08 g / dL (consumption of 70/56 grams of ethanol for men / women) in a period of 2 hours. The mechanisms that mediate organic damage induced by ethanol consumption in a binge pattern are not known. Therefore, the development of experimental models that allow a better understanding of these mechanisms is of interest. The hypothesis of this study is that consumption in binge activates AT 1 receptors that will promote an increase in systemic oxidative stress. Therefore, the present project was designed to investigate the participation of AT 1 receptors in systemic oxidative stress induced by the consumption of ethanol in a binge pattern. For this purpose, Wistar Hannover rats aged between 60 and 70 days (270 to 300 g) were randomly assigned to 4 groups: 1) Control: the animals had free access to water and received daily water by gavage; 2) Binge ethanol: the animals had free access to water and received ethanol at a dose of 2 g / kg (10 mL / kg of a 26% v./v. Solution) by gavage for a period of 5 weeks. Ethanol was administered 4 days a week; 3) Losartan: the animals had free access to water and received losartan (10 mg / kg) daily by gavage; 4) Ethanol binge + losartan: the animals had free access to water and received ethanol at a dose of 2 g / kg per gavage for a period of 5 weeks. These animals also received losartan (10 mg / kg) daily by gavage. At the end of the treatment, the animals were anesthetized with 1.25 g / kg urethane in 25% solution (5 mL / kg) and killed by exsanguination followed by rupture of the diaphragm. Blood and heart (left ventricle) were collected for biochemical analysis. Treatment with ethanol did not change the weight of the animals during the treatment. There were no differences in feed and water consumption between groups over the 5 weeks of treatment. The results showed that the consumption of ethanol in a binge pattern did not alter the plasma concentration of substances reactive to thiobarbituric acid (TBARS) and hydrogen peroxide (H 2 O 2 ) as well as the plasma activity of the enzymes superoxide dismutase (SOD), the plasma concentration of reduced glutathione (GSH) and plasma catalase activity. A similar profile was observed in the left ventricle, in addition to not observing ERK 1/2 protein expression. As a result, ethanol consumption in binge did not alter systemic and tissue oxidative stress or alter antioxidant defense systems.

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

Cited by 9 publications

References 27 publications

Prognostic Impacts of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Coronary Syndrome Patients Without Heart Failure

Prognostic Impacts of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Coronary Syndrome Patients Without Heart Failure

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

Efeito do consumo de etanol em padrão binge sobre o estresse oxidativo sistêmico

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