Use of renin-angiotensin system antagonists post-PCI is associated with lower mortality in patients with reduced and preserved left ventricular (LV) function.

Abstract

Background: Guidelines support prescribing angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II-receptor blockers (ARBs) post-PCI in patients with LV dysfunction, diabetes and hypertension. Guidelines are based on older trials, and with advancements in PCI evidence investigating the long-term effects of ACEi/ARB use in patients with reduced and preserved ejection fraction (EF) post-PCI is lacking. Methods and Results: 21,388 patients with ACS from the Melbourne Interventional Group registry that underwent PCI (2005-2018) and alive at 30day follow-up were reviewed. At follow-up 83.8% were on ACEi/ARBs, and were comparably younger (mean age 63.5 vs 64.6years, p=0.001), included less men (74.2% vs 77.5%, p=0.001), had greater mean BMI (28.6 vs 27.4, p=0.001), hypertension (60.8% vs 52.2%, p=0.001), and lower prevalence of prior MI (17.3% vs 19.6%, p=0.001). Overall, those who had a STEMI (53.6% vs 41.1%, p=0.001) were more likely, while those with NSTEMI less likely to receive an ACEi/ARB (46.4% vs 58.9%, p=0.001). Overall, ACEi/ARB use was associated with a significant reduction in mortality (15.0% vs 22.7%; p<0.001; mean follow-up 5.5years). Sub-group analysis revealed ACEi/ARBs provide a mortality benefit across reduced and preserved EF (Figure). Conclusion: Prescribing of ACEi/ARBs post-PCI is high, and associated with significantly reduced mortality in both reduced and preserved LV function, ACEi/ARBs should be considered for all patients post-PCI regardless of LV function.