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Published on: January 28, 2020
Renin-angiotensin system blockade reduces cardiovascular events in nonheart failure, stable patients with prior
Young Choi1, Sungmin Lim2, Kwan Yong Lee3
1Department of Internal Medicine, Division of Cardiology, College of Medicine, Seoul St Mary's Hospital.
Insights
Renin-angiotensin system (RAS) blockers significantly reduced major adverse cardiovascular events and all-cause death in patients with stable coronary artery disease (SCAD) without heart failure after percutaneous coronary intervention. These findings support RAS blockade as a preventive therapy.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Conflicting evidence exists regarding the efficacy of renin-angiotensin system (RAS) blockade in patients with stable coronary artery disease (SCAD).
- This study investigates the long-term clinical outcomes of RAS blockers in SCAD patients without heart failure (HF) who underwent percutaneous coronary intervention (PCI) with drug-eluting stents.
Purpose of the Study:
- To evaluate the long-term effects of RAS blockers on clinical outcomes in patients with SCAD without HF post-PCI.
- To determine if RAS blockade reduces major adverse cardiovascular events (MACE) and all-cause death in this specific patient population.
Main Methods:
- A large-scale, multicenter, prospective cohort registry of 5722 SCAD patients was analyzed.
- Patients were divided into RAS blocker and no RAS blocker groups post-PCI, excluding those with LVEF < 50% or history of HF/MI.
- MACE was defined as cardiovascular death, nonfatal MI, or stroke. Propensity score matching was used to control for confounding factors.
Main Results:
- RAS blockers were associated with a significant reduction in MACE (adjusted HR: 0.781) and all-cause death (adjusted HR: 0.788) during a median follow-up of 29.7 months.
- These benefits were consistent in the propensity score matched cohort (MACE: adjusted HR: 0.679; all-cause death: adjusted HR: 0.723).
- RAS blockade did not significantly affect the risk of coronary revascularization but showed sustained benefits across predefined subgroups.
Conclusions:
- RAS blockers are effective preventive therapies for reducing long-term cardiovascular events in patients with SCAD without HF who underwent PCI.
- The findings support the use of RAS blockers to improve clinical outcomes in this patient cohort.
- Further research may explore specific RAS blocker agents and their comparative effectiveness.
Background:
The effects of renin-angiotensin system (RAS) blockade on the clinical outcome in patients with stable coronary artery disease (SCAD) are conflicting. We evaluated the long-term effects of RAS blockers (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker) on the clinical outcomes in patients with SCAD without heart failure (HF) who underwent percutaneous coronary intervention (PCI) with drug-eluting stent using a large-scale, multicenter, prospective cohort registry.
Methods:
A total of 5722 patients with SCAD were enrolled and divided into two groups according to the use of RAS blockers after PCI: RAS blocker group included 4070 patients and no RAS blocker group included 1652 patients. Exclusion criteria were left ventricular ejection fraction less than 50% and the history of HF or myocardial infarction. A major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, nonfatal myocardial infarction, and stroke.
Results:
During a median follow-up of 29.7 months, RAS blockers were associated with a significant reduction in the risk of MACE [adjusted hazard ratio (HR): 0.781; 95% confidence interval (CI): 0.626-0.975; P=0.015] and all-cause death (adjusted HR: 0.788; 95% CI: 0.627-0.990; P=0.041) but did not affect the risk of coronary revascularization. In the propensity score matched cohort, overall findings were consistent (MACE: adjusted HR: 0.679; 95% CI: 0.514-0.897; P=0.006; all-cause death: adjusted HR: 0.723; 95% CI: 0.548-0.954; P=0.022), and the benefit of RAS blockade was maintained in all predefined subgroups.
Conclusion:
This study demonstrated that RAS blockers were effective preventive therapies for reducing long-term cardiovascular events in patients with SCAD without HF who underwent PCI.
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