Key result
ACE inhibitor use in patients with end-stage renal disease after cardiac events was associated with a 37% reduction in all-cause mortality over three years.
Why the study?
Do ACE inhibitors reduce long-term all-cause mortality in patients with end-stage renal disease after cardiac events?
Cohort (n=386)
No
Do ACE inhibitors reduce long-term all-cause mortality in patients with end-stage renal disease after cardiac events?
ACE inhibitors are associated with a significant reduction in long-term all-cause mortality without increasing adverse hemodynamic or arrhythmic complications in ESRD patients following cardiac events.
Answers are grounded in this paper and cite their sources.
May support ACE inhibitor consideration in ESRD post-cardiac events; leaves open need for RCT confirmation of survival benefit.
UNLABELLED: HYPOTHESIS/INTRODUCTION: The risks and benefits of angiotensin-converting enzyme (ACE) inhibitors in patients with end-stage renal disease (ESRD) after cardiac events are unknown. We sought to determine the independent effect of ACE inhibitors (ACE-I) on long-term mortality in ESRD patients after cardiac events. MATERIALS AND METHODS: We analysed a prospective coronary care unit registry and identified 527 ESRD patients, 368 with complete data on medications prescribed, over eight years at a single, tertiary centre. RESULTS: The overall mean age was 64.4+13.8 years with 54.9% men, and 59.2% African-American. A total of 143/386 (37.0%) were prescribed ACE-I during the hospital stay for cardiac reasons, including congestive heart failure (CHF) 52.8% and acute coronary syndromes (ACS) 47.2%. There were no significant differences in the rates of hypotension or arrhythmias in those who were treated with ACE-I versus those who were not. Survival analysis over three years, adjusted for known confounders, demonstrated a 37% reduction in all-cause mortality in those who received ACE-I, (p=0.0145). CONCLUSIONS: In the setting of coronary care unit admission for CHF and ACS, ESRD patients selected for ACE-I, did not have increased rates of adverse haemodynamic or arrhythmic complications. The use of ACE-I conferred an independent mortality reduction over long-term follow-up.
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McCullough et al. (2002) conducted a cohort in End-stage renal disease (ESRD) after cardiac events (n=386). Angiotensin-converting enzyme inhibitors (ACE-I) vs. No ACE-I was evaluated on All-cause mortality (37% reduction, p=0.0145). ACE inhibitor use in patients with end-stage renal disease after cardiac events was associated with a 37% reduction in all-cause mortality over three years.
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