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

Xuedong Zhao; Guanqi Zhao; Mengge Zhou; Ge Wang; Changsheng Ma; Sidney C Smith Jr; Gregg C Fonarow; Louise Morgan; Bin Que; Hui Ai; Jing Liu; Dong Zhao; Shaoping Nie

doi:10.3389/fcvm.2022.1003442

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

Front Cardiovasc Med. 2022 Sep 29:9:1003442. doi: 10.3389/fcvm.2022.1003442. eCollection 2022.

Authors

Xuedong Zhao¹, Guanqi Zhao¹, Mengge Zhou², Ge Wang¹, Changsheng Ma³, Sidney C Smith Jr⁴, Gregg C Fonarow⁵, Louise Morgan⁶, Bin Que¹, Hui Ai¹, Jing Liu⁷, Dong Zhao⁷, Shaoping Nie¹

Affiliations

¹ Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
² Vanke School of Public Health, Tsinghua University, Beijing, China.
³ Division of Cardiology, Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁴ Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
⁵ Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States.
⁶ Department of International Quality Improvement, American Heart Association, Dallas, TX, United States.
⁷ The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.

Abstract

Background: Few 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).

Objectives: This 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.

Methods: This 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.

Results: Of 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).

Conclusion: This 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.

Keywords: ACEI/ARB; AMI; CCC-ACS; PCI; low blood pressure; mortality.