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    Relation between previous Angiotensin-converting enzyme inhibitor use and in-hospital outcomes in acute coronary syndromes

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    Authors
    Singh, Sheldon M.
    Goodman, Shaun G.
    Yan, Raymond T.
    Dery, Jean-Pierre
    Wong, Graham C.
    Gallo, Richard
    Grondin, Francois R.
    Lai, Kevin
    Lopez-Sendon, Jose
    Fox, Keith A. A.
    Yan, Andrew T.
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    UMass Chan Affiliations
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2012-02-01
    Keywords
    Acute Coronary Syndrome
    Angiotensin-Converting Enzyme Inhibitors
    Cardiovascular Diseases
    Health Services Research
    
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    Link to Full Text
    http://dx.doi.org/10.1016/j.amjcard.2011.09.018
    Abstract
    Angiotensin-converting enzyme (ACE) inhibitor use in patients at high risk of coronary artery disease has been associated with a decrease in the risk of myocardial infarction (MI) and death. However, it is unclear whether chronic use of these agents modifies the course and outcome of an acute coronary syndrome (ACS). This study assessed the association between chronic use of ACE inhibitors and clinical outcomes in patients with ACS. From 1999 through 2008, 13,632 Canadian patients with ACS were identified in the Global Registry of Acute Coronary Events (GRACE), the expanded GRACE (GRACE(2)), and the Canadian Registry of Acute Coronary Events (CANRACE). Patients were stratified by previous use of an ACE inhibitor. Clinical characteristics, in-hospital treatment, and outcomes were compared between the 2 groups. Multivariable logistic regression analysis adjusting for GRACE risk score and other clinical factors was performed. Patients receiving an ACE inhibitor before the ACS had a higher prevalence of diabetes (40.6% vs 21.2%, p <0.001), previous MI (51.8% vs 23.3%, p <0.001), heart failure (18.0% vs 6.9%), and higher GRACE scores at presentation (133 vs 124, p <0.001). Multivariable analysis demonstrated no significant association between previous ACE inhibitor use and death (adjusted odds ratio [OR] 1.15, confidence interval [CI] 0.90 to 1.49, p = 0.27), in-hospital re-MI (adjusted OR 0.99, CI 0.78 to 1.25, p = 0.91), or the composite end point of death/re-MI (adjusted OR 1.01, CI 0.84 to 1.20, p = 0.94). In conclusion, previous use of an ACE inhibitor is not independently associated with improved in-hospital outcomes after an ACS.
    Source
    Am J Cardiol. 2012 Feb 1;109(3):332-6. Epub 2011 Nov 11. Link to article on publisher's site
    DOI
    10.1016/j.amjcard.2011.09.018
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27279
    PubMed ID
    22078966
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.amjcard.2011.09.018
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