Association between Angiotensin-Converting Enzyme Inhibitors and Troponin in Acute Coronary Syndrome

Abstract

BackgroundCardiovascular disease is the leading cause of mortality in the western world and its treatment should be optimized to decrease severe adverse events.ObjectiveTo determine the effect of previous use of angiotensin-converting enzyme inhibitors on cardiac troponin I measurement in patients with acute coronary syndrome without ST-segment elevation and evaluate clinical outcomes at 180 days.MethodsProspective, observational study, carried out in a tertiary center, in patients with acute coronary syndrome without ST-segment elevation. Clinical, electrocardiographic and laboratory variables were analyzed, with emphasis on previous use of angiotensin-converting enzyme inhibitors and cardiac troponin I. The Pearson chi-square tests (Pereira) or Fisher's exact test (Armitage) were used, as well as the non-parametric Mann-Whitney's test. Variables with significance levels of <10% were submitted to multiple logistic regression model.ResultsA total of 457 patients with a mean age of 62.1 years, of whom 63.7% were males, were included. Risk factors such as hypertension (85.3%) and dyslipidemia (75.9%) were the most prevalent, with 35% of diabetics. In the evaluation of events at 180 days, there were 28 deaths (6.2%). The statistical analysis showed that the variables that interfered with troponin elevation (> 0.5 ng / mL) were high blood glucose at admission (p = 0.0034) and ST-segment depression ≥ 0.5 mm in one or more leads (p = 0.0016). The use of angiotensin-converting inhibitors prior to hospitalization was associated with troponin ≤ 0.5 ng / mL (p = 0.0482). The C-statistics for this model was 0.77.ConclusionThis study showed a correlation between prior use of angiotensin-converting enzyme inhibitors and reduction in the myocardial necrosis marker troponin I in patients admitted for acute coronary syndrome without ST-segment elevation. However, there are no data available yet to state that this reduction could lead to fewer severe clinical events such as death and re-infarction at 180 days.

Risk of Cardiovascular Death in the Remote Period after Myocardial Revascularization and in Association with Renal Dysfunction

“…L.Minuzzo et al [11] investigated the effect of previous use of angiotensin-converting enzyme inhibitors on cardiac troponin I measurement in patients with acute coronary syndrome without ST-segment elevation and clinical outcomes at 180 days. This study showed a correlation between prior use of ACEIs and reduction in the myocardial necrosis marker troponin I in patients admitted for acute coronary syndrome without ST-segment elevation.…”

Desenvolvimento De Estratégias Farmacoterapêuticas Para O Infarto Agudo Do Miocárdio: Desafios E Novas Perspectivas, Parte Ii

“…O uso mais comum de anti-hipertensivo na farmacoterapia cardiovascular pósinfarto são os antagonistas de receptores de angiotensina I, as evidências clínicas mostram que pacientes pós-infartados melhoraram a função cardíaca e reduziram o reinfarto. Esses efeitos foram atribuídos à diminuição do remodelamento cardíaco em indivíduos com disfunção ventricular esquerda, graças a modulação no sistema renina-angiotensina-aldosterona (MINUZZO et al, 2014;LEE et al, 2016). Adicionalmente, os antagonistas dos receptores para aldosterona, como o eplerone aperfeiçoou o tratamento farmacológico múltiplo aplicado com inibidores da enzima conversora de angiotensina, aspirina, betabloqueador e estatinas, reduzindo 17% a mortalidade de indivíduos pós-infarto em comparação com o grupo placebo com mesmo protocolo farmacoterapêutico (PITT et al, 2003).…”

Acute coronary syndrome in elderly: aspects of patient management

“…L. Minuzzo и соавт. показали, что у больных, госпитализированных по поводу ОКСбпST, которым ранее назначались иАПФ, было отмечено снижение уровня маркера некроза миокарда тропонина I, однако данных, подтверждающих, что это снижение может ассоциироваться с меньшим количеством тяжелых клинических исходов, таких как смерть и повторный инфаркт в течение 180 дней, получено не было [29]. β-адреноблокаторы β-адреноблокаторы показаны всем пациентам с ОКС при отсутствии противопоказаний, таких как атриовентрикулярная блокада II и III степени, снижение систолического артериального давления >100 мм рт.…”