Abstract 12197: Angiotensin-Converting Enzyme Inhibitors Are Associated with Better All-Cause Mortality and Improved Cardiovascular Outcome in Aortic Stenosis
Background: Angiotensin-converting enzyme inhibitors (ACEI) had been perceived to be relatively contraindicated in aortic stenosis (AS) because of their vasodilatory properties. However, there is emerging evidence that ACEI may actually be beneficial in AS.
Hypothesis: We hypothesized that ACEI therapy in patients with AS is associated with lower all-cause mortality and better cardiovascular (CV) outcome in a large population-based cohort.
Methods: The Health Informatics Centre (HIC) dispensed prescribing database for the population of Tayside, Scotland (∼400,000 people) was linked to a large echocardiogram database (>110,000 scans) by a unique patient identifier that records all healthcare events in the region. Patients with incident AS (defined as peak aortic gradient >20 mmHg) between 1993 and 2008 were identified. Cox regression analysis was used to assess differences in all-cause mortality and CV events (CV death or hospitalizations) between those treated with and without ACEI adjusted for multiple confounders including age, left ventricular function, peak aortic valve gradient, co-morbidities and concurrent therapy.
Results: A total of 2621 subjects with varying degree of AS (aged 72.8 ± 12.5, 47% males) were identified. Mean follow-up was 4.7±4.0 years. 836 (32%) patients received ACEI. There were 1185 (45%) all-cause deaths and 1282 (49%) CV events. Those treated with ACEI had significantly lower all-cause mortality and fewer CV events. The adjusted hazard ratio (HR) was 0.68 (95% CI 0.54–0.87) for all-cause mortality and 0.74 (95% CI 0.60–0.93) for CV events in patients treated with ACEI. For a propensity score matched cohort analysis, the adjusted HR for CV events was 0.77 (95%CI 0.61–0.97).
Conclusions: This is the largest retrospective data on the use of ACEI in AS. Our results suggest that ACEI therapy may be associated with improved mortality and CV outcome in patients with AS.
- © 2010 by American Heart Association, Inc.