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Relation between previous angiotensin-converting enzyme inhibitor use and in-hospital outcomes in acute coronary syndromes.
Am J Cardiol. 2012 Feb 01; 109(3):332-6.AJ

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.

Authors+Show Affiliations

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22078966

Citation

Singh, Sheldon M., et al. "Relation Between Previous Angiotensin-converting Enzyme Inhibitor Use and In-hospital Outcomes in Acute Coronary Syndromes." The American Journal of Cardiology, vol. 109, no. 3, 2012, pp. 332-6.
Singh SM, Goodman SG, Yan RT, et al. Relation between previous angiotensin-converting enzyme inhibitor use and in-hospital outcomes in acute coronary syndromes. Am J Cardiol. 2012;109(3):332-6.
Singh, S. M., Goodman, S. G., Yan, R. T., Dery, J. P., Wong, G. C., Gallo, R., Grondin, F. R., Lai, K., Lopez-Sendon, J., Fox, K. A., & Yan, A. T. (2012). Relation between previous angiotensin-converting enzyme inhibitor use and in-hospital outcomes in acute coronary syndromes. The American Journal of Cardiology, 109(3), 332-6. https://doi.org/10.1016/j.amjcard.2011.09.018
Singh SM, et al. Relation Between Previous Angiotensin-converting Enzyme Inhibitor Use and In-hospital Outcomes in Acute Coronary Syndromes. Am J Cardiol. 2012 Feb 1;109(3):332-6. PubMed PMID: 22078966.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relation between previous angiotensin-converting enzyme inhibitor use and in-hospital outcomes in acute coronary syndromes. AU - Singh,Sheldon M, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Dery,Jean-Pierre, AU - Wong,Graham C, AU - Gallo,Richard, AU - Grondin,Francois R, AU - Lai,Kevin, AU - Lopez-Sendon,Jose, AU - Fox,Keith A A, AU - Yan,Andrew T, AU - ,, Y1 - 2011/11/11/ PY - 2011/07/20/received PY - 2011/09/07/revised PY - 2011/09/07/accepted PY - 2011/11/15/entrez PY - 2011/11/15/pubmed PY - 2012/3/7/medline SP - 332 EP - 6 JF - The American journal of cardiology JO - Am J Cardiol VL - 109 IS - 3 N2 - 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. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/22078966/Relation_between_previous_angiotensin_converting_enzyme_inhibitor_use_and_in_hospital_outcomes_in_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(11)02931-6 DB - PRIME DP - Unbound Medicine ER -