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Mortality benefit of angiotensin-converting enzyme inhibitors after cardiac events in patients with end-stage renal disease
Peter A McCullough
William Beaumont Hospital, Divisions of Cardiology, Nutrition and Preventive Medicine, Royal Oak, MI, Henry Ford Health System, pmc975@ yahoo.com
Keisha R Sandberg
Henry Ford Heart and Vascular Institute
Jerry Yee
Henry Ford Hospital, Department of Internal Medicine, Division of Hypertension and Nephrology, Beaumont Health Center, 4949 Coolidge, Royal Oak, MI 48073, USA
Michael P Hudson
Henry Ford Heart and Vascular Institute
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.
Key Words: coronary care unit • end-stage renal disease • angiotensin-converting enzyme inhibitors • survival • arrhythmias • complications
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Journal of Renin-Angiotensin-Aldosterone System, Vol. 3, No. 3,
188-191 (2002)
DOI: 10.3317/jraas.2002.040
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