Key result
Early ACEI/ARB therapy within 24 hours of admission was associated with reduced in-hospital mortality in ACS patients with advanced renal dysfunction (RR 0.68; 95% CI 0.55-0.84).
Why the study?
The clinical efficacy of early ACEI/ARB therapy within 24 h of admission in ACS patients with advanced renal dysfunction remains unclear.
Does early ACEI/ARB therapy reduce in-hospital mortality in ACS patients with advanced renal dysfunction?
Cohort (n=7,204)
Yes
Does early ACEI/ARB therapy reduce in-hospital mortality in ACS patients with advanced renal dysfunction?
Early initiation of ACEI/ARB therapy within 24 hours of admission is associated with significantly reduced in-hospital mortality in ACS patients with advanced renal dysfunction.
Early ACEI/ARB use was associated with lower in-hospital mortality; leaves open a potential benefit pending randomized confirmation.
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 AND RESULTS: 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 1:1 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).
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Li et al. (2023) conducted a cohort in Acute coronary syndrome with advanced renal dysfunction (n=7,204). Early ACEI/ARB therapy vs. No early ACEI/ARB therapy was evaluated on In-hospital mortality (RR 0.68, 95% CI 0.55-0.84). Early ACEI/ARB therapy within 24 hours of admission was associated with reduced in-hospital mortality in ACS patients with advanced renal dysfunction (RR 0.68; 95% CI 0.55-0.84).
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