Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/30506
Title: Role of renin-angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction.
Austin Authors: Prosser, Hamish C;Peck, Kah Yong;Dinh, Diem;Roberts, Louise;Chandrasekhar, Jaya;Brennan, Angela;Duffy, Stephen J;Clark, David J ;Ajani, Andrew E;Oqueli, Ernesto;Sebastian, Martin;Reid, Christopher M;Freeman, Melanie;Sajeev, Jithin K;Teh, Andrew W 
Affiliation: Department of Cardiology, Eastern Health, Box Hill Hospital, Level 2, 8 Arnold Street, Box Hill, VIC, 3128, Australia..
Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia..
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia..
Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia..
School of Medicine, Deakin University, Geelong, Australia..
Department of Cardiology, Alfred Health, The Alfred Hospital, Melbourne, VIC, Australia..
Cardiology
Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia..
Department of Cardiology, Ballarat Health Services, Ballarat, VIC, Australia..
Department of Cardiology, Barwon Health, University Hospital, Geelong, VIC, Australia..
School of Public Health, Curtin University, Perth, WA, Australia..
Issue Date: Jul-2022
Date: 2022
Publication information: Clinical Research in Cardiology 2022; 111(7):776-786.
Abstract: The use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II-receptor blockers (ARBs) post-myocardial infarction (MI) is supported by evidence based on trials performed in the thrombolysis era. This was prior to primary percutaneous coronary intervention (PCI) being routine practice, and with little direct evidence for the use of these medications in patients with preserved left ventricular (LV) function. This study sought to determine whether there is an association between ACEi/ARB use after PCI for acute coronary syndrome (ACS) and long-term all-cause mortality, with a particular focus on patients with preserved LV function. This multicentre, observational study evaluated prospectively collected data of 21,388 patients (> 18 years old) that underwent PCI for NSTEMI and STEMI between 2005 and 2018, and were alive at 30 day follow-up. In total, 83.8% of patients were using ACEi/ARBs. Kaplan-Meier analysis demonstrated ACEi/ARB use was associated with a significantly lower mortality in the entire cohort (15.0 vs. 22.7%; p < 0.001) with a mean follow-up of 5.58 years; and independently associated with 24% lower mortality by Cox proportional hazards modelling (HR 0.76, CI 0.67-0.85, p < 0.001). ACEi/ARB therapy was also associated with significantly lower mortality in patients with reduced or preserved LV function, with greater survival benefit with worse LV dysfunction. ACEi/ARB therapy post-PCI is associated with significantly lower long-term mortality in patients with reduced and preserved LV function. These findings provide contemporary evidence for using these agents in the current era of routine primary PCI, including those with preserved EF.
URI: https://ahro.austin.org.au/austinjspui/handle/1/30506
DOI: 10.1007/s00392-021-01985-x
ORCID: 0000-0003-4074-3610
Journal: Clinical research in cardiology : official journal of the German Cardiac Society
PubMed URL: 35050405
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35050405/
Type: Journal Article
Subjects: Angiotensin converting enzyme inhibitors
Angiotensin receptor blockers
Heart failure
Percutaneous coronary intervention
STEMI/NSTEMI
Appears in Collections:Journal articles

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