Early ACEI/ARB use and in-hospital outcomes of acute myocardial infarction patients with systolic blood pressure <100 mmHg and undergoing percutaneous coronary intervention: Findings from the CCC-ACS project

Abstract

BackgroundFew studies have evaluated whether acute myocardial infarction (AMI) patients with relatively low blood pressure benefit from early ACEI/ARB use in the era of percutaneous coronary intervention (PCI).ObjectivesThis study evaluated the associations of ACEI/ARB use within 24 h of admission with in-hospital outcomes among AMI patients with SBP &amp;lt; 100 mmHg and undergoing PCI.MethodsThis study was based on the Improving Care for Cardiovascular Disease in China-ACS project, a collaborative registry and quality improvement project of the American Heart Association and the Chinese Society of Cardiology. Between November 2014 and December 2019, a total of 94,623 patients with AMI were enrolled. Of them, 4,478 AMI patients with SBP &amp;lt; 100 mmHg and undergoing PCI but without clinically diagnosed cardiogenic shock at admission were included. Multivariable logistic regression and propensity score-matching analysis were used to evaluate the association between early ACEI/ARB use and in-hospital major adverse cardiac events (MACEs), a combination of all-cause death, cardiogenic shock, and cardiac arrest.ResultsOf AMI patients, 24.41% (n = 1,093) were prescribed ACEIs/ARBs within 24 h of admission. Patients with early ACEI/ARB use had a significantly lower rate of MACEs than those without ACEI/ARB use (1.67% vs. 3.66%, p = 0.001). In the logistic regression analysis, early ACEI/ARB use was associated with a 45% lower risk of MACEs (odds ratio: 0.55, 95% CI: 0.33–0.93; p = 0.027). Further propensity score-matching analysis still showed that patients with early ACEI/ARB use had a lower rate of MACEs (1.96% vs. 3.93%, p = 0.009).ConclusionThis study found that among AMI patients with an admission SBP &amp;lt; 100 mmHg undergoing PCI, early ACEI/ARB use was associated with better in-hospital outcomes. Additional studies of the early use of ACEIs/ARBs in AMI patients with relatively low blood pressure are warranted.

Effect of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on In‐Hospital Outcomes Based on Renal Function Among Critically Ill Patients: Findings From the Medical Information Mart for Intensive Care IV Database

“…22 In patients with AMI, the cardioprotective mechanism of early administration of an ACEI/ARB could be attributed to reduction of RAAS activation and infarct size. 5 Moreover, we found a greater benefit for early administration of an ACEI/ARB in patients with obesity. Activation of the RAAS plays a central role in HTN, dyslipidemia, and insulin resistance in patients with obesity.…”

“…Although ARB inhibits angiotensin II type 2 receptor, they are associated with lower levels of bradykinin and nitric oxide when compared to ACEI, and it has been found that ARB increases levels of angiotensin II to lead the upregulation of angiotensin‐converting enzyme 2, which has been demonstrated to provide protection for renal function 22 . In patients with AMI, the cardioprotective mechanism of early administration of an ACEI/ARB could be attributed to reduction of RAAS activation and infarct size 5 . Moreover, we found a greater benefit for early administration of an ACEI/ARB in patients with obesity.…”

“…[19][20][21] Wu et al 22 found that ARB was associated with lower risk of adverse events in patients with AKI. Zhao et al 5 found that ARB use was significantly associated with a reduced risk of major adverse cardiovascular events among patients with AMI. Messerli et al 20 found that there was no difference in the efficacy of ACEI and ARB in the treatment of HTN, cardiovascular diseases, and renal dysfunction.…”

“…Angiotensin‐converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have been demonstrated to be effective in critically ill patients. Studies have found that ACEI/ARB use was associated with reduced risk of ICU mortality and adverse events in the patients with acute myocardial infarction (AMI), 5 acute respiratory distress syndrome, 6 and heart failure. ACEI/ARB targets the renin–angiotensin–aldosterone system (RAAS) to exert their pharmacological effects.…”

Investigation of the Therapeutic Potential of Organic Nitrates in Mortality Reduction Following Acute Myocardial Infarction in Hyperlipidemia Patients: A Population-Based Cohort Study

“…Daisaku et al reported that beta-blocker treatment is still effective in the long-term outcomes of STEMI survivors without LV systolic dysfunction for secondary prevention after AMI [22]. The benefits of ACEI mainly appeared in higher-risk subgroups, but the survival benefit for patients in low-risk subgroups without these features is unclear [23,24]. In our study population, around 50% of the patients had an age below 65 years, and one-third were male (Table 1).…”