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

2021 ◽  
Author(s):  
Jiong Xiao ◽  
Lin-Ze Liu ◽  
Wen-Hua Lin
Keyword(s):  
Enzyme Inhibitors ◽  
Systolic Function ◽  
Angiotensin Receptor Blockers ◽  
Left Ventricular Systolic Function ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Left Ventricular ◽  
Angiotensin Receptor ◽  
Ventricular Systolic Function ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Abstract Background We investigated the clinical results of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) 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 ACEIs or ARBs. Methods A total of 1627 UA patients with preserved left ventricular systolic function who successfully underwent PCI were enrolled. We classified those patients into two groups: the ACEI group (n=918) and the ARB group (n=709) based on discharge medications. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs), including all-cause death, nonfatal myocardial infarction (MI), stroke and target vessel revascularization (TVR), with a follow-up period of 13 months. The secondary endpoint was the occurrence of separate components of MACCEs. We applied the Kaplan–Meier method to depict survival curves, while intergroup differences were performed using the log-rank test. Multivariable Cox regression analysis was applied to assess the prognostic influence of various factors. To balance potential confounding biases derived from differences in baseline levels, propensity score matching (PSM) was used to adjust for confounders between the ACEI and ARB groups. Results After PSM, 660 pairs in each group were created. There were no differences in MACCEs (HR=0.860, 95%CI: 0.465-1.590, P=0.630), all-cause death (HR=0.334, 95%CI: 0.090-1.238, P=0.101), non-fatal MI (HR=4.929, 95%CI: 0.576-42.195, P=0.145), stroke (HR=1.049, 95%CI: 0.208-5.290, P=0.954) and TVR (HR=1.276, 95% CI: 0.537-3.031, P=0.581) between the ACEI and ARB groups. Conclusions Prognoses were comparable between ACEI or ARB treatment in UA patients who had preserved left ventricular systolic function after PCI.

Abstract 17433: Improved Outcomes in Septic Shock With Pre-hospitalization Use of Angiotensin-converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sagger Mawri ◽  
Jainil Shah ◽  
Jain Tarun ◽  
Rami Dirani ◽  
Alexander Michaels ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Left Ventricular ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Icu Admission ◽  
Improved Outcomes ◽  
Receptor Blockers

Background: The neurohormonal effects of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are well recognized. Recent molecular studies have also demonstrated novel immune-modulating properties of ACEI/ARB through reduction of pro-inflammatory cytokines. In a recent study, obese trauma patients on pre-injury ACEI/ARB had reduced multi-organ failure scores and improved T cell function and monocyte maturation as compared to those not on ACEI/ARB. We sought to determine whether pre-hospital use of ACEI/ARB conferred improvements in outcomes in patients with septic shock (SS). Methods: We evaluated 248 patients admitted to the ICU with SS from January 2011 to April 2013. Comprehensive baseline demographic, clinical and echocardiographic data was obtained at time of ICU admission. We identified 90 patients on ACEI/ARB prior to ICU admission. Chi-square and t-tests were used to assess for differences in clinical parameters and outcomes in patients who were on ACE/ARB prior to ICU admission (ACE/ARB group) versus those not on ACEI/ARB prior to ICU admission (non-ACEI/ARB group). Results: Patients in the ACE/ARB group (36%) had significantly lower heart rate (95.8 bpm vs 102.3 bpm, p<0.05), higher MAP (80 mmHg vs 74 mmHg, p<0.05), higher serum potassium level (4.3 mEq/L vs 4.0 mEq/L, p<0.05), and less urine output (522cc vs 708cc per initial 24 hours, p<0.05) with a non-significant trend towards lower respiratory rate, WBC count, lactate level and APACHE 2 score. The ACEI/ARB group had higher left ventricular systolic diameter (1.26 cm vs 1.17 cm, p<0.05) and left ventricular posterior wall diameter (1.18 cm vs 1.07 cm, p<0.05); however, there were no other statistically significant echocardiographic differences between both groups. In-hospital and 90-day mortality was significantly less in the ACE/ARB group compared to the non-ACE/ARB group (20% vs 31.7%, p <0.05) and (25.6% vs 38%, p <0.05), respectively. Conclusion: ACEI/ARB use prior to ICU admission is associated with improved outcomes in SS patients, not explained by laboratory or echocardiographic differences. This provides further support for the possible immunomodulating benefits of ACEI/ARBs; however, more studies are needed to confirm these findings.

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