Impact of renin-angiotensin system inhibitors after revascularization of patients with left main coronary artery disease
| Autor: | Björn Redfors, W. Morris Brown, Arie Pieter Kappetein, Nicholas Lembo, Ori Ben-Yehuda, Gregg W. Stone, Shmuel Chen, Aaron Crowley, Iva Srdanovic, Joseph F. Sabik, Patrick W. Serruys |
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| Přispěvatelé: | Cardiothoracic Surgery |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Target vessel revascularization Target vessel Coronary Artery Disease Revascularization Renin-Angiotensin System Angiotensin Receptor Antagonists Percutaneous Coronary Intervention Risk Factors Internal medicine Renin–angiotensin system medicine Humans cardiovascular diseases Left main coronary artery disease Aged business.industry Percutaneous coronary intervention General Medicine Middle Aged Treatment Outcome surgical procedures operative medicine.anatomical_structure Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Coronary Artery Disease, 31(1), 37-44. Lippincott Williams & Wilkins |
| ISSN: | 0954-6928 |
| DOI: | 10.1097/mca.0000000000001053 |
| Popis: | Background: There is a paucity of data regarding the effect of inhibition of the renin-angiotensin system on outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). We sought to examine long-term outcomes of patients with left main coronary disease (LMCAD) randomized to PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents or CABG according to treatment at discharge with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in the large-scale, multicenter, randomized EXCEL trial. Methods: EXCEL randomized 1905 patients with LMCAD of low and intermediate anatomical complexity (visually-assessed SYNTAX score ≤32) to PCI (n = 948) versus CABG (n = 957). Patients were categorized according to whether they were treated with ACEI/ARB at discharge; their outcomes from discharge to 5 years were examined using multivariable logistic regression with an offset for follow-up time. Results: Among 1775 patients discharged alive with known ACEI/ARB treatment status, 896 (50.5%) were treated with one of these agents. Among those treated with ACEI/ARB, the 5-year rate of all-cause death was similar after PCI or CABG (10.7% versus 9.8% respectively, adjOR, 0.94; 95% CI, 0.56-1.57) in contrast to patients not treated with ACEI/ARB (15.0% versus 7.8%, respectively, adjOR, 2.20; 95% CI, 1.32-3.67) (Pinteraction = 0.02). Significant interactions between treatment arm (PCI versus CABG) and ACEI/ARB treatment status were also found for cardiovascular death (Pinteraction = 0.03), ischemia-driven revascularization (Pinteraction = 0.03), target vessel revascularization (Pinteraction = 0.007) and target vessel failure (Pinteraction = 0.0009). Conclusion: In the EXCEL trial, the postdischarge rates of death and revascularization after 5 years were similar after PCI and CABG in patients with LMCAD treated with ACEI/ARB at discharge. In contrast, event rates were higher after PCI versus CABG in those not so treated. |
| Databáze: | OpenAIRE |
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