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Bruno F, Ascenzo FD, Muñoz-Pousa I, Saia F, Vaira MP, Baldi E, Leone PP, Cabanas-Grandio P, Corcione N, Spinoni E, Annibali G, Russo C, Ziacchi M, Caruzzo CA, Ferlini M, Lanzillo G, Filippo OD, Gallone G, Castagno D, Patti G, Musumeci G, Giordano A, Stefanini G, Salizzoni S, Rordorf R, Essi EA, Rubin SR, Biffi M, Conrotto F, Ferrari GMD. 302 Impact of right ventricular pacing in patients with TAVI underwent permanent pacemaker implantation: the Pace-TAVI International Multicentre Study. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Permanent pacemaker implantation after transcatheter aortic valve implantation (TAVI) has emerged as a relevant issue, being more frequent than after surgery and the progressive shift towards low-risk patients stressed the importance to reduce the risk of complications that could impact patient’s long-term prognosis. Long-term right ventricular pacing has been related to an increased risk of electromechanical asynchrony, negative left-ventricular remodelling, atrial fibrillation and heart failure, but there is a lack of evidence regarding the prognostic impact on TAVI patients. The aim of this international multicentre study is to assess the impact of right ventricular pacing on prognosis of TAVI patients undergone pacemaker implantation after the procedure due to conduction disorders.
Methods and results
All the consecutive patients with severe aortic stenosis treated with TAVI and subsequently underwent pacemaker implantation in each participating centre were enrolled. Patients were divided into two subgroups according to the percentage of ventricular pacing (VP cut-off: 40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality and hospitalization for heart failure in subgroups based on the percentage of ventricular stimulation. All cause and cardiovascular mortality in the subgroups according to the percentage of ventricular pacing were the secondary endpoints. In total, 427 patients were enrolled, 153 patients with VP < 40% and 274 with a with VP ≥ 40%. Patients with VP ≥ 40% were older (81.16 ± 6.4 years vs. 80.51 ± 6.8 years), with higher NYHA class, a lower EF (55.26 ± 12.2 vs. 57.99 ± 11.3 P = 0.03), an increased end diastolic ventricular volume (112.11 ± 47.6 vs. 96.60 ± 40.4, P = 0.005) and diameter (48.89 ± 9.7 vs. 45.84 ± 7.5 P = 0.01). A higher incidence of moderate post-procedural paravalvular leak was observed in patients with VP ≥ 40% (37.5% vs. 26.85%, P = 0.03). Ventricular pacing ≥40% was associated with a higher incidence of the composite primary endpoint of CV mortality and HF hospitalization (p at log rank test = 0.006, adjusted HR: 2.41; 95% CI: 1.03–5.6; P = 0.04). Patients with ventricular pacing ≥ 40% had also a higher risk of all-cause (p at log rank test = 0.03, adjusted HR = 1.57; 95% CI: 1.03–2.38; P = 0.03) and cardiovascular (p at log ank test =0.008, adjusted HR: 3.77; CI: 1.32–10.78; P = 0.006) mortality compared to patients with a VP < 40%.
Conclusions
TAVI Patients underwent permanent pacemaker implantation after the procedure due to conduction disorders and with a VP ≥ 40% at follow-up are at increased risk of cardiovascular death and HF hospitalizations and of all-cause mortality compared to patients with a VP < 40%. It is mandatory to reduce the percentage of ventricular pacing at follow-up when possible or consider left ventricular branch pacing and biventricular pacing in TAVI patients.
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Affiliation(s)
- Francesco Bruno
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Fabrizio D’ Ascenzo
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Isabel Muñoz-Pousa
- Servicio de Cardiologia, Hospital Universitario Alvaro Cunquerio, Vigo, Pontevedra, Spain
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola, Bologna, Italy
| | - Matteo Pio Vaira
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Enrico Baldi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | | | - Pilar Cabanas-Grandio
- Servicio de Cardiologia, Hospital Universitario Alvaro Cunquerio, Vigo, Pontevedra, Spain
| | - Nicola Corcione
- Unita Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Roma, Italy
| | - Enrico Spinoni
- Division of Cardiology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Gianmarco Annibali
- S.C. Cardiologia, Azienda Ospedaliera Ordine Mauriziano Umberto I, Torino, Italy
| | - Caterina Russo
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Matteo Ziacchi
- Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola, Bologna, Italy
| | - Carlo Alberto Caruzzo
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Marco Ferlini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Lanzillo
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Ovidio De Filippo
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Guglielmo Gallone
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Davide Castagno
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Giuseppe Patti
- Division of Cardiology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Giuseppe Musumeci
- S.C. Cardiologia, Azienda Ospedaliera Ordine Mauriziano Umberto I, Torino, Italy
| | - Arturo Giordano
- Unita Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Roma, Italy
| | - Giulio Stefanini
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Stefano Salizzoni
- Dipartimento di Cardiochirurgia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Roberto Rordorf
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Emad Abu Essi
- Servicio de Cardiologia, Hospital Universitario Alvaro Cunquerio, Vigo, Pontevedra, Spain
| | | | - Mauro Biffi
- Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola, Bologna, Italy
| | - Federico Conrotto
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
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Raposeiras-Roubín S, Abu-Assi E, Caneiro Queija B, Cobas Paz R, D’Ascenzo F, Henriques JPS, Saucedo J, González-Juanatey J, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Song X, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Huczek Z, Nie SP, Fujii T, Correia L, Kawashiri MA, Cespón Fernández M, Muñoz-Pousa I, López Rodríguez E, Castiñeira-Busto M, Barreiro Pardal C, García-Acuña JM, Southern D, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Gaita F, Kowara M, Filipiak K, Wang X, Yan Y, Fan JY, Ikari Y, Nakahayshi T, Sakata K, Yamagishi M, Kedev S, Íñiguez-Romo A. Incidence, predictors and prognostic impact of intracranial bleeding within the first year after an acute coronary syndrome in patients treated with percutaneous coronary intervention. European Heart Journal. Acute Cardiovascular Care 2020; 9:764-770. [PMID: 31042052 DOI: 10.1177/2048872619827471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The rate of intracranial haemorrhage after an acute coronary syndrome has been studied in detail in the era of thrombolysis; however, in the contemporary era of percutaneous coronary intervention, most of the data have been derived from clinical trials. With this background, we aim to analyse the incidence, timing, predictors and prognostic impact of post-discharge intracranial haemorrhage in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
Methods:
We analysed data from the BleeMACS registry (patients discharged for acute coronary syndrome and undergoing percutaneous coronary intervention from Europe, Asia and America, 2003–2014). Analyses were conducted using a competing risk framework. Uni and multivariate predictors of intracranial haemorrhage were assessed using the Fine–Gray proportional hazards regression analysis. The endpoint was 1-year post-discharge intracranial haemorrhage.
Results:
Of 11,136 patients, 30 presented with intracranial haemorrhage during the first year (0.27%). The median time to intracranial haemorrhage was 150 days (interquartile range 55.7–319.5). The fatality rate of intracranial haemorrhage was very high (30%). After multivariate analysis, only age (subhazard ratio 1.05, 95% confidence interval 1.01–1.07) and prior stroke/transient ischaemic attack (hazard ratio 3.29, 95% confidence interval 1.36–8.00) were independently associated with a higher risk of intracranial haemorrhage. Hypertension showed a trend to associate with higher intracranial haemorrhage rate. The combination of older age (⩾75 years), prior stroke/transient ischaemic attack, and/or hypertension allowed us to identify most of the patients with intracranial haemorrhage (86.7%). The annual rate of intracranial haemorrhage was 0.1% in patients with no risk factors, 0.2% in those with one factor, 0.6% in those with two factors and 1.3% in those with three factors.
Conclusion:
The incidence of intracranial haemorrhage in the first year after an acute coronary syndrome treated with percutaneous coronary intervention is low. Advanced age, previous stroke/transient ischaemic attack, and hypertension are the main predictors of increased intracranial haemorrhage risk.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wouter J Kikkert
- University of Amsterdam, Academic Medical Center, the Netherlands
| | | | | | | | | | | | | | | | | | - Shao-Ping Nie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Neriman Osman
- Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | - Hiroki Shiomi
- University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | - Xiao Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Yan
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing-Yao Fan
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuji Ikari
- Tokai University School of Medicine, Tokyo, Japan
| | | | - Kenji Sakata
- University Graduate School of Medicine, Kanazawa, Japan
| | | | - Sasko Kedev
- University Clinic of Cardiology, Skopje, Republic of Macedonia
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Raposeiras-Roubín S, Abu-Assi E, Muñoz-Pousa I, Rossello X, Cespón-Fernández M, Melendo Viu M, Caneiro-Queija B, Cobas-Paz R, Bastos G, Iñíguez-Romo A. Usefulness of Bleeding After Acute Coronary Syndromes for Unmasking Silent Cancer. Am J Cardiol 2020; 125:1801-1808. [PMID: 32307091 DOI: 10.1016/j.amjcard.2020.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
There is a growing body of evidence on the incidence and negative prognostic impact of postdischarge hemorrhagic complications after an acute coronary syndrome (ACS). However, the risk of subsequent cancer after postdischarge bleeding in these patients is currently poorly known. The aim of this study was to assess the association of postdischarge bleeding with newly diagnosed cancers after an ACS. Data from a single-center registry of 3,644 ACS patients, who were discharged with dual antiplatelet therapy and treated with percutaneous coronary intervention, were used to investigate the association between postdischarge bleeding and diagnosis of cancer. During a median follow-up of 56.2 months, bleeding events were documented in 1,216 patients and newly diagnosed cancers in 227 patients. Postdischarge bleeding was associated with cancer diagnosis (adjusted hazard ratio [HR] 3.43, 95% confidence interval [CI] 2.62 to 4.50), but only spontaneous bleeding (adjusted HR 4.38, 95% CI 3.31 to 5.79). This association was stronger as the severity of the bleeding increased (HR 1.52, 4.88, 7.30, and 12.29, for BARC type 1, 2, 3a, and 3b bleeding, respectively). Positive predictive values for cancer diagnosis of postdischarge bleeding was 7.7%. Median time from bleeding to cancer was 4.6 months. In conclusion, spontaneous postdischarge bleeding in ACS patients is strongly associated with subsequent cancer diagnosis within the first 6 months. A prompt evaluation of bleeding could be useful for enabling an early detection of cancer in these patients.
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Affiliation(s)
| | - Emad Abu-Assi
- Department of Cardiology, University Hospital Alvaro Cunqueir,. Vigo, Pontevedra, Spain
| | - Isabel Muñoz-Pousa
- Department of Cardiology, University Hospital Alvaro Cunqueir,. Vigo, Pontevedra, Spain
| | - Xavier Rossello
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - María Melendo Viu
- Department of Cardiology, University Hospital Alvaro Cunqueir,. Vigo, Pontevedra, Spain
| | | | - Rafael Cobas-Paz
- Department of Cardiology, University Hospital Alvaro Cunqueir,. Vigo, Pontevedra, Spain
| | - Guillermo Bastos
- Department of Cardiology, University Hospital Alvaro Cunqueir,. Vigo, Pontevedra, Spain
| | - Andrés Iñíguez-Romo
- Department of Cardiology, University Hospital Alvaro Cunqueir,. Vigo, Pontevedra, Spain
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4
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Raposeiras-Roubín S, Abu-Assi E, Paz RC, Rosselló X, Barreiro Pardal C, Piñón Esteban M, Pascual CR, García Comesaña J, González-Carrero López A, Caneiro-Queija B, Cespón-Fernández M, Muñoz-Pousa I, Domínguez-Erquicia P, Domínguez-Rodríguez LM, Carpintero A, García E, Ibáñez B, Iñíguez-Romo A. Impact of malnutrition in the embolic–haemorrhagic trade-off of elderly patients with atrial fibrillation. Europace 2020; 22:878-887. [DOI: 10.1093/europace/euaa017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/29/2020] [Indexed: 12/15/2022] Open
Abstract
Abstract
Aims
Nutrition is an important determinant of health above the age of 80 years. Malnutrition in the elderly is often underdiagnosed. The aim of this study was to report the prevalence and prognostic value of malnutrition in patients ≥80 years old with atrial fibrillation (AF) with and without anticoagulant therapy.
Methods and results
We assessed the nutritional status of 4724 octogenarian patients with diagnoses of AF in a single centre from Spain between 2014 and 2017 with the CONUT score. Malnutrition was confirmed in 2036 patients (43.1%). Anticoagulation prescription was more frequent in patients with good nutrition than in those malnourished (79.5% vs. 71.7%, P < 0.001). The impact of malnutrition on mortality was evaluated by Cox regression, whereas its association with ischaemic stroke and major bleeding was studied through competing risk analysis. After multivariate adjusting, malnutrition was associated with mortality [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.24–1.49], stroke [sub-distribution HR (sHR) 1.37, 95% CI 1.10–1.69], and major bleeding (sHR 1.29, 95% CI 1.02–1.64). In anticoagulated patients, the embolic–haemorrhagic trade-off event was virtually neutral for those who had normal nutritional status [average daily rates (ADRs) for stroke and bleeding: 4.70 and 4.69 per 100 000 patients/day, respectively; difference = +0.01 per 100 000 patients/day; P = 0.99] and negative for those with malnutrition (ADR for stroke and bleeding: 5.38 and 7.61 per 100 000 patients/day, respectively; difference = −2.23 per 100 000 patients/day; P = 0.07).
Conclusion
Malnutrition is very common in octogenarian patients with AF, being a clinical predictor for poor prognosis. For anticoagulated patients, malnutrition was associated with a negative embolic–haemorrhagic balance.
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Affiliation(s)
- Sergio Raposeiras-Roubín
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Rafael Cobas Paz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Xavier Rosselló
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | | | - Miguel Piñón Esteban
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Carlos Rodriguez Pascual
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Julio García Comesaña
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | | | - Berenice Caneiro-Queija
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - María Cespón-Fernández
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Isabel Muñoz-Pousa
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Pablo Domínguez-Erquicia
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | | | - Alberto Carpintero
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Enrique García
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Andrés Iñíguez-Romo
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Spain
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Raposeiras-Roubín S, Alonso Rodríguez D, Camacho Freire SJ, Abu-Assi E, Cobas-Paz R, Rodríguez Pascual C, García Comesaña J, González-Carrero López A, Cubelos Fernández N, López-Masjuán Ríos Á, Cespón-Fernández M, Muñoz-Pousa I, Caneiro-Queija B, Rodríguez Albarrán A, Castañera SÁ, Guillén JV, Carpintero Vara A, Barreiro Pardal C, Domínguez-Erquicia P, Domínguez-Rodríguez LM, Díaz Fernández JF, Fernández Vázquez F, Iñíguez-Romo A. Vitamin K Antagonists and Direct Oral Anticoagulants in Nonagenarian Patients With Atrial Fibrillation. J Am Med Dir Assoc 2020; 21:367-373.e1. [DOI: 10.1016/j.jamda.2019.08.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/23/2019] [Accepted: 08/30/2019] [Indexed: 02/01/2023]
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Cespón-Fernández M, Raposeiras-Roubín S, Abu-Assi E, Manzano-Fernández S, Flores-Blanco P, Barreiro-Pardal C, Castiñeira-Busto M, Muñoz-Pousa I, López-Rodríguez E, Caneiro-Queija B, Cobas-Paz R, Fernández-Barbeira S, Domínguez-Erquicia P, Domínguez-Rodríguez LM, López-Cuenca Á, Gómez-Molina M, Baz-Alonso JA, Calvo-Iglesias F, Valdés-Chávarri M, Íñiguez-Romo A. Renin-Angiotensin System Blockade and Risk of Heart Failure After Myocardial Infarction Based on Left Ventricular Ejection Fraction: A Retrospective Cohort Study. Am J Cardiovasc Drugs 2019; 19:487-495. [PMID: 30924021 DOI: 10.1007/s40256-019-00343-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The goal of this study was to determine the association between the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and follow-up heart failure (HF) according to left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction (AMI). METHODS This cohort study used a retrospective registry of 8169 consecutive patients discharged with a diagnosis of AMI from two university hospitals in Spain between 2010 and 2016. We used a multivariable competing risk analysis, survival-time inverse probability weighting (IPW) propensity score adjusting, and propensity score matching (PSM) to investigate the association between ACEI/ARB treatment and follow-up HF. RESULTS During the follow-up (3.3 ± 2.2 years), 1296 patients were admitted for HF (5.2 per 100 person-years). ACEI/ARB use was not associated with fewer follow-up HF admissions in patients with LVEF > 40% (univariate analysis: sub-hazard ratio [sHR] 1.10; 95% confidence interval [CI] 0.95-1.27; p = 0.197; IPW adjusting analysis: sHR 1.11; 95% CI 0.95-1.29; p = 0.192; PSM analysis: sHR 1.12; 95% CI 0.92-1.36; p = 0.248). However, ACEI/ARB use was associated with a significant reduction in HF admission rates in patients with LVEF ≤ 40% (univariate analysis: HR 0.70; 95% CI 0.56-0.88; p = 0.003; IPW adjusting analysis: HR 0.64; 95% CI 0.50-0.83; p = 0.001; PSM analysis: HR 0.65; 95% CI 0.46-0.92; p = 0.014). CONCLUSION Among hospitalized survivors of AMI, the use of ACEIs/ARBs was associated with a lower risk of follow-up HF in patients with LVEF ≤ 40% but not in those with LVEF > 40%. Further prospective studies are needed to confirm our results.
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Affiliation(s)
- María Cespón-Fernández
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain.
| | - Sergio Raposeiras-Roubín
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - Emad Abu-Assi
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | | | - Pedro Flores-Blanco
- Cardiology Department, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Cristina Barreiro-Pardal
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - María Castiñeira-Busto
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - Isabel Muñoz-Pousa
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - Elena López-Rodríguez
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - Berenice Caneiro-Queija
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - Rafael Cobas-Paz
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - Saleta Fernández-Barbeira
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - Pablo Domínguez-Erquicia
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | | | - Ángel López-Cuenca
- Cardiology Department, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Miriam Gómez-Molina
- Cardiology Department, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - José Antonio Baz-Alonso
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | - Francisco Calvo-Iglesias
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
| | | | - Andrés Íñiguez-Romo
- Cardiology Department, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212, Vigo, Pontevedra, Spain
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Raposeiras-Roubín S, Abu-Assi E, Cespón-Fernández M, Ibáñez B, García-Ruiz JM, D'Ascenzo F, Simao Henriques JP, Saucedo J, Caneiro-Queija B, Cobas-Paz R, Muñoz-Pousa I, Wilton SB, González Juanatey JR, Kikkert WJ, Núñez-Gil I, Ariza-Solé A, Song X, Alexopoulos D, Liebetrau C, Kawaji T, Gaita F, Huczek Z, Nie SP, Yan Y, Fujii T, Correia L, Kawashiri MA, Kedev S, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Kowara M, Filipiak K, Wang X, Fan JY, Ikari Y, Nakahayshi T, Sakata K, Yamagishi M, Kalpak O, Íñiguez-Romo A. Impact of renin-angiotensin system blockade on the prognosis of acute coronary syndrome based on left ventricular ejection fraction. ACTA ACUST UNITED AC 2019; 73:114-122. [PMID: 31105064 DOI: 10.1016/j.rec.2019.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/21/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES For patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI), it is unclear whether angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are associated with reduced mortality, particularly with preserved left ventricular ejection fraction (LVEF). The goal of this study was to determine the association between ACEI/ARB and mortality in ACS patients undergoing PCI, with and without reduced LVEF. METHODS Data from the BleeMACS registry were used. The endpoint was 1-year all-cause mortality. The prognostic value of ACEI/ARB was tested after weighting by survival-time inverse probability and after adjustment by Cox regression, propensity score, and instrumental variable analysis. RESULTS Among 15 401 ACS patients who underwent PCI, ACEI/ARB were prescribed in 75.2%. There were 569 deaths (3.7%) during the first year after hospital discharge. After multivariable adjustment, ACEI/ARB were associated with lower 1-year mortality, ≤ 40% (HR, 0.62; 95%CI, 0.43-0.90; P=.012). The relative risk reduction of ACEI/ARB in mortality was 46.1% in patients with LVEF ≤ 40%, and 15.7% in patients with LVEF> 40% (P value for treatment-by-LVEF interaction=.008). For patients with LVEF> 40%, ACEI/ARB was associated with lower mortality only in ST-segment elevation myocardial infarction (HR, 0.44; 95%CI, 0.21-0.93; P=.031). CONCLUSION The benefit of ACEI/ARB in decreasing mortality after an ACS in patients undergoing PCI is concentrated in patients with LVEF ≤ 40%, and in those with LVEF> 40% and ST-segment elevation myocardial infarction. In non-ST-segment elevation-ACS patients with LVEF> 40%, further studies are needed to assess the prognostic impact of ACEI/ARB.
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Affiliation(s)
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - María Cespón-Fernández
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | | | - Fabrizio D'Ascenzo
- Cardiology Department, San Giovanni Battista Molinette Hospital, Turin, Italy
| | | | - Jorge Saucedo
- Cardiology Department, NorthShore University Hospital, Chicago, Illinois, United States
| | | | - Rafael Cobas-Paz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Isabel Muñoz-Pousa
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Stephen B Wilton
- Cardiology Department, Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | | | - Wouter J Kikkert
- Cardiology Department, University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Iván Núñez-Gil
- Servicio de Cardiología, Hospital San Carlos, Madrid, Spain
| | | | - Xiantao Song
- Cardiology Department, Anzhen Hospital, Beijing, China
| | | | - Christoph Liebetrau
- Cardiology Department, Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | - Tetsuma Kawaji
- Cardiology Department, University Graduate School of Medicine, Kyoto, Japan
| | - Fiorenzo Gaita
- Cardiology Department, San Giovanni Battista Molinette Hospital, Turin, Italy
| | - Zenon Huczek
- Cardiology Department, University Clinical Hospital, Warsaw, Poland
| | - Shao-Ping Nie
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Yan
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Toshiharu Fujii
- Cardiology Department, Tokai University School of Medicine, Tokai, Japan
| | - Luis Correia
- Cardiology Department, Hospital Sao Rafael, Salvador, Brazil
| | - Masa-Aki Kawashiri
- Cardiology Department, University Graduate School of Medicine, Kanazawa, Japan
| | - Sasko Kedev
- Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Danielle Southern
- Cardiology Department, Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - Emilio Alfonso
- Servicio de Cardiología, Hospital San Carlos, Madrid, Spain
| | - Belén Terol
- Servicio de Cardiología, Hospital San Carlos, Madrid, Spain
| | - Alberto Garay
- Servicio de Cardiología, Hospital Bellvitge, Barcelona, Spain
| | | | - Yalei Chen
- Cardiology Department, Anzhen Hospital, Beijing, China
| | | | - Neriman Osman
- Cardiology Department, Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | - Helge Möllmann
- Cardiology Department, Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | - Hiroki Shiomi
- Cardiology Department, University Graduate School of Medicine, Kyoto, Japan
| | - Francesca Giordana
- Cardiology Department, San Giovanni Battista Molinette Hospital, Turin, Italy
| | - Michal Kowara
- Cardiology Department, University Clinical Hospital, Warsaw, Poland
| | | | - Xiao Wang
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing-Yao Fan
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuji Ikari
- Cardiology Department, University Graduate School of Medicine, Kanazawa, Japan
| | - Takuya Nakahayshi
- Cardiology Department, University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Cardiology Department, University Graduate School of Medicine, Kanazawa, Japan
| | - Masakazu Yamagishi
- Cardiology Department, University Graduate School of Medicine, Kanazawa, Japan
| | - Oliver Kalpak
- Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Andrés Íñiguez-Romo
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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