ACE Inhibitors Not Linked to Improved Outcomes After ACS

Prior use of ACE inhibitors does not improve in-hospital outcomes after acute coronary syndrome

THURSDAY, Jan. 26 (HealthDay News) -- For patients with acute coronary syndrome (ACS), prior chronic use of an angiotensin-converting enzyme (ACE) inhibitor is not independently associated with improved in-hospital outcomes, according to a study published in the Feb. 1 issue of The American Journal of Cardiology.

Sheldon M. Singh, M.D., of the Sunnybrook Health Sciences Centre in Toronto, and colleagues investigated the association between chronic use of ACE inhibitors and clinical outcomes for patients with ACS. Participants included 13,632 Canadian patients with ACS, identified from 1999 through 2008 from the Global Registry of Acute Coronary Events (GRACE), the expanded GRACE, and the Canadian Registry of Acute Coronary Events (CANRACE).

The researchers found that patients who received chronic ACE inhibitor therapy before the ACS had a significantly higher prevalence of diabetes (40.6 versus 21.2 percent), previous myocardial infarction (51.8 vs. 23.3 percent), and higher GRACE scores at presentation (133 versus 124), compared with those who did not take ACE inhibitors. On multivariable analysis, there was no significant association between prior ACE inhibitor use and death, in-hospital myocardial re-infarction, or the composite end point of death/myocardial re-infarction.

"In contrast to benefits reported with the early use of an ACE inhibitor after a myocardial infarction, a favorable association between chronic ACE inhibitor use and clinical events with an ACS was not demonstrated even after adjusting for multiple important demographic, clinical, and therapeutic variables," the authors write.

GRACE receives funding from Sanofi-Aventis, and the Canadian GRACE and CANRACE were partially funded by Sanofi-Aventis and Bristol-Myers Squibb.

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