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Effects of Angiotensin-Converting Enzyme Inhibitors/Angiotensin II Receptor Blockers on Prognosis in Acute Coronary

Yike Li1, Enmin Xie2, Qiang Chen1

  • 1Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100029, China.

Cardiovascular Drugs and Therapy
|June 10, 2025
PubMed

Insights

Angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use in dialysis patients with acute coronary syndrome did not improve major adverse cardiovascular events. However, these drugs significantly reduced all-cause and cardiovascular mortality, especially in those with impaired left ventricular ejection fraction.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Evidence for angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) use post-myocardial infarction (MI) primarily comes from the thrombolysis era.
  • Limited data exist on ACEI/ARB benefits in patients with preserved left ventricular ejection fraction (LVEF), particularly those undergoing regular dialysis.
  • Existing trials often exclude dialysis patients, necessitating specific research in this population.

Purpose of the Study:

  • To investigate the 5-year outcomes of ACEI/ARB use in patients with acute coronary syndrome (ACS) on regular dialysis and preserved left ventricular function.
  • To assess the association between ACEI/ARB treatment and major adverse cardiovascular events (MACE), all-cause mortality, and cardiovascular mortality.
  • To explore potential differential effects of ACEI/ARB based on LVEF levels.

Main Methods:

  • A multicenter retrospective study involving 1249 dialysis patients diagnosed with coronary artery disease (CAD).
  • Analysis focused on 603 patients who met specific inclusion and exclusion criteria.
  • Data collected included patient demographics, treatment regimens (ACEI/ARB use), and 5-year clinical outcomes.

Main Results:

  • The study cohort (n=603) had a mean age of 61.7 years, with 70.6% males; 51.9% received ACEI/ARB.
  • No significant benefit of ACEI/ARB was observed for the composite MACE outcome (31.3% vs. 29.0%, p=0.988).
  • ACEI/ARB use was associated with a significant reduction in all-cause mortality (24.9% vs. 33.1%, p=0.012) and cardiovascular deaths (14.7% vs. 21.4%, p=0.015).
  • A more pronounced benefit on cardiovascular mortality was noted in patients with LVEF between 50-60%.

Conclusions:

  • In dialysis patients with ACS and preserved LVEF, ACEI/ARB therapy significantly reduces all-cause and cardiovascular mortality.
  • The survival benefit of ACEI/ARB appears more pronounced in patients with moderately reduced LVEF (50-60%).
  • ACEI/ARB treatment did not demonstrate a benefit in reducing the composite MACE outcome in this specific patient group.
Abstract

Keywords:
Acute coronary syndromeAngiotensin converting enzyme inhibitorsAngiotensin receptor blockersDialysis

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