Renin-angiotensin system inhibition and in-hospital mortality in acute coronary syndrome patients with advanced renal dysfunction: findings from CCC-ACS project and a nationwide electronic health record-based cohort in China.
Eur Heart J Qual Care Clin Outcomes
; 9(8): 785-795, 2023 Dec 22.
Article
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| MEDLINE
| ID: mdl-36731865
ABSTRACT
AIMS:
In acute coronary syndrome (ACS) patients without advanced renal dysfunction [estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2], early (within 24 h of admission) angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) is the guideline-directed medical therapy. The clinical efficacy of early ACEI/ARB therapy among ACS patients with advanced renal dysfunction remains unclear. METHODS ANDRESULTS:
Among 184 850 ACS patients hospitalized from July 2014 to December 2018 in the Chinese National Electronic Disease Surveillance System Platform (CNEDSSP) cohort and 113 650 ACS patients enrolled from November 2014 to December 2019 in the Improving Care for Cardiovascular Disease in China-ACS Project (CCC-ACS) cohort, we identified 3288 and 3916 ACS patients with admission eGFR < 30 mL/min/1.73 m2 [2647 patients treated with ACEI/ARB (36.7%)], respectively. After 11 propensity score matching (PSM) in each cohort, Kaplan-Meier analysis showed that early ACEI/ARB use was associated with a 39% [hazard ratio (HR) 0.61, 95% confidence interval (95% CI) 0.45-0.82] and a 34% (HR 0.66, 95% CI 0.46-0.95) reduction in in-hospital mortality in CNEDSSP and CCC-ACS cohorts, respectively, which was consistent in multiple sensitivity analyses. A random effect meta-analysis of the two cohorts after PSM revealed a 32% reduction (risk ratio 0.68, 95% CI 0.55-0.84) in in-hospital mortality among ACEI/ARB users.CONCLUSIONS:
Based on two nationwide cohorts in China in contemporary practice, we demonstrated that ACEI/ARB therapy initiated within 24 h of admission is associated with a reduction in in-hospital mortality in ACS patients with advanced renal dysfunction. CLINICAL TRIAL REGISTRATION CCC-ACS project was registered at URL https//www.clinicaltrials.gov. (Unique identifier NCT02306616).Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Síndrome Coronario Agudo
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Enfermedades Renales
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Guideline
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Prognostic_studies
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Risk_factors_studies
Idioma:
En
Revista:
Eur Heart J Qual Care Clin Outcomes
Año:
2023
Tipo del documento:
Article