Early ACEI/ARB use and in-hospital outcomes of acute myocardial infarction patients with systolic blood pressure <100 mmHg and undergoing percutaneous coronary intervention: Findings from the CCC-ACS project

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  • Zhao, Xuedong
    • Other Affiliation: Beijing Anzhen Hospital
  • Zhao, Guanqi
    • Other Affiliation: Beijing Anzhen Hospital
  • Zhou, Mengge
    • Other Affiliation: Tsinghua University
  • Wang, Ge
    • Other Affiliation: Beijing Anzhen Hospital
  • Ma, Changsheng
    • Other Affiliation: Beijing Anzhen Hospital
  • Smith, Sidney C.
    • Affiliation: School of Medicine, Division of Cardiology, Department of Medicine
  • Fonarow, Gregg C.
    • Other Affiliation: University of California, Los Angeles
  • Morgan, Louise
    • Other Affiliation: American Heart Association
  • Que, Bin
    • Other Affiliation: Beijing Anzhen Hospital
  • Ai, Hui
    • Other Affiliation: Beijing Anzhen Hospital
  • Liu, Jing
    • Other Affiliation: Capital Medical University
  • Zhao, Dong
    • Other Affiliation: Capital Medical University
  • Nie, Shaoping
    • Other Affiliation: Beijing Anzhen Hospital
Abstract
  • BackgroundFew studies have evaluated whether acute myocardial infarction (AMI) patients with relatively low blood pressure benefit from early ACEI/ARB use in the era of percutaneous coronary intervention (PCI).ObjectivesThis study evaluated the associations of ACEI/ARB use within 24 h of admission with in-hospital outcomes among AMI patients with SBP < 100 mmHg and undergoing PCI.MethodsThis study was based on the Improving Care for Cardiovascular Disease in China-ACS project, a collaborative registry and quality improvement project of the American Heart Association and the Chinese Society of Cardiology. Between November 2014 and December 2019, a total of 94,623 patients with AMI were enrolled. Of them, 4,478 AMI patients with SBP < 100 mmHg and undergoing PCI but without clinically diagnosed cardiogenic shock at admission were included. Multivariable logistic regression and propensity score-matching analysis were used to evaluate the association between early ACEI/ARB use and in-hospital major adverse cardiac events (MACEs), a combination of all-cause death, cardiogenic shock, and cardiac arrest.ResultsOf AMI patients, 24.41% (n = 1,093) were prescribed ACEIs/ARBs within 24 h of admission. Patients with early ACEI/ARB use had a significantly lower rate of MACEs than those without ACEI/ARB use (1.67% vs. 3.66%, p = 0.001). In the logistic regression analysis, early ACEI/ARB use was associated with a 45% lower risk of MACEs (odds ratio: 0.55, 95% CI: 0.33–0.93; p = 0.027). Further propensity score-matching analysis still showed that patients with early ACEI/ARB use had a lower rate of MACEs (1.96% vs. 3.93%, p = 0.009).ConclusionThis study found that among AMI patients with an admission SBP < 100 mmHg undergoing PCI, early ACEI/ARB use was associated with better in-hospital outcomes. Additional studies of the early use of ACEIs/ARBs in AMI patients with relatively low blood pressure are warranted.
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  • Article
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  • In Copyright
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  • Attribution 4.0 International
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  • Frontiers in Cardiovascular Medicine
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  • 9
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  • English
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  • 2297-055X

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