Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction
Aims: 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 pra...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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SPRINGER HEIDELBERG
2022
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93089 |
| _version_ | 1848765694322147328 |
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| author | Prosser, H.C. Peck, K.Y. Dinh, D. Roberts, L. Chandrasekhar, J. Brennan, A. Duffy, S.J. Clark, D. Ajani, A.E. Oqueli, E. Sebastian, M. Reid, Christopher Freeman, M. Sajeev, J.K. Teh, A.W. |
| author_facet | Prosser, H.C. Peck, K.Y. Dinh, D. Roberts, L. Chandrasekhar, J. Brennan, A. Duffy, S.J. Clark, D. Ajani, A.E. Oqueli, E. Sebastian, M. Reid, Christopher Freeman, M. Sajeev, J.K. Teh, A.W. |
| author_sort | Prosser, H.C. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Aims: 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. Methods: 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. Results: 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. Conclusion: 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. Graphical abstract: [Figure not available: see fulltext.] |
| first_indexed | 2025-11-14T11:39:19Z |
| format | Journal Article |
| id | curtin-20.500.11937-93089 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:39:19Z |
| publishDate | 2022 |
| publisher | SPRINGER HEIDELBERG |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-930892023-09-18T01:12:16Z Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction Prosser, H.C. Peck, K.Y. Dinh, D. Roberts, L. Chandrasekhar, J. Brennan, A. Duffy, S.J. Clark, D. Ajani, A.E. Oqueli, E. Sebastian, M. Reid, Christopher Freeman, M. Sajeev, J.K. Teh, A.W. Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Angiotensin converting enzyme inhibitors Angiotensin receptor blockers STEMI/NSTEMI Percutaneous coronary intervention Heart failure ST-SEGMENT ELEVATION LEFT-VENTRICULAR DYSFUNCTION CONVERTING-ENZYME-INHIBITOR ACUTE MYOCARDIAL-INFARCTION TASK-FORCE CARDIOVASCULAR EVENTS SYSTOLIC FUNCTION EUROPEAN-SOCIETY MANAGEMENT TRIAL Angiotensin converting enzyme inhibitors Angiotensin receptor blockers Heart failure Percutaneous coronary intervention STEMI/NSTEMI Adolescent Angiotensin Receptor Antagonists Angiotensin-Converting Enzyme Inhibitors Humans Percutaneous Coronary Intervention Renin-Angiotensin System Stroke Volume Humans Angiotensin-Converting Enzyme Inhibitors Stroke Volume Renin-Angiotensin System Adolescent Angiotensin Receptor Antagonists Percutaneous Coronary Intervention Aims: 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. Methods: 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. Results: 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. Conclusion: 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. Graphical abstract: [Figure not available: see fulltext.] 2022 Journal Article http://hdl.handle.net/20.500.11937/93089 10.1007/s00392-021-01985-x English http://purl.org/au-research/grants/nhmrc/1111170 http://purl.org/au-research/grants/nhmrc/1136372 http://creativecommons.org/licenses/by/4.0/ SPRINGER HEIDELBERG fulltext |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Angiotensin converting enzyme inhibitors Angiotensin receptor blockers STEMI/NSTEMI Percutaneous coronary intervention Heart failure ST-SEGMENT ELEVATION LEFT-VENTRICULAR DYSFUNCTION CONVERTING-ENZYME-INHIBITOR ACUTE MYOCARDIAL-INFARCTION TASK-FORCE CARDIOVASCULAR EVENTS SYSTOLIC FUNCTION EUROPEAN-SOCIETY MANAGEMENT TRIAL Angiotensin converting enzyme inhibitors Angiotensin receptor blockers Heart failure Percutaneous coronary intervention STEMI/NSTEMI Adolescent Angiotensin Receptor Antagonists Angiotensin-Converting Enzyme Inhibitors Humans Percutaneous Coronary Intervention Renin-Angiotensin System Stroke Volume Humans Angiotensin-Converting Enzyme Inhibitors Stroke Volume Renin-Angiotensin System Adolescent Angiotensin Receptor Antagonists Percutaneous Coronary Intervention Prosser, H.C. Peck, K.Y. Dinh, D. Roberts, L. Chandrasekhar, J. Brennan, A. Duffy, S.J. Clark, D. Ajani, A.E. Oqueli, E. Sebastian, M. Reid, Christopher Freeman, M. Sajeev, J.K. Teh, A.W. Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction |
| title | Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction |
| title_full | Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction |
| title_fullStr | Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction |
| title_full_unstemmed | Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction |
| title_short | Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction |
| title_sort | role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction |
| topic | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Angiotensin converting enzyme inhibitors Angiotensin receptor blockers STEMI/NSTEMI Percutaneous coronary intervention Heart failure ST-SEGMENT ELEVATION LEFT-VENTRICULAR DYSFUNCTION CONVERTING-ENZYME-INHIBITOR ACUTE MYOCARDIAL-INFARCTION TASK-FORCE CARDIOVASCULAR EVENTS SYSTOLIC FUNCTION EUROPEAN-SOCIETY MANAGEMENT TRIAL Angiotensin converting enzyme inhibitors Angiotensin receptor blockers Heart failure Percutaneous coronary intervention STEMI/NSTEMI Adolescent Angiotensin Receptor Antagonists Angiotensin-Converting Enzyme Inhibitors Humans Percutaneous Coronary Intervention Renin-Angiotensin System Stroke Volume Humans Angiotensin-Converting Enzyme Inhibitors Stroke Volume Renin-Angiotensin System Adolescent Angiotensin Receptor Antagonists Percutaneous Coronary Intervention |
| url | http://purl.org/au-research/grants/nhmrc/1111170 http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93089 |