Abstract 20664: Prognostic Impact of Angiotensin-Converting Enzyme Inhibitor Therapy in Patients With Acute Coronary Syndromes despite Nonobstructive Coronary Artery Disease
Purpose Patients with nonobstructive coronary artery disease (CAD) despite an acute coronary syndrome (ACS) are usually dismissed from specialty care with the belief that they do not have serious cardiac disease. Available data on the treatment and prognosis of these patients are limited.
Methods: The EMMACE-2 registry enrolled patients who had been hospitalized for an ACS. We analyzed the data of the British EMMACE 2 (Evaluation of Methods and Management of Acute Coronary Events) in an attempt to clarify the effects of early intensive medical therapy in these patients. There were 1602 patients who had cardiac catheterization that were used for this analysis. The main outcome measures were evidence based therapies prescribed at discharge and 6-month incidence of all cause mortality.
Results: The cohort consisted of 1252 patients with obstructive CAD (>50% luminal diameter obstructed) and 350 patients without obstructive CAD. In the overall population, in-hospital standard ACS therapies were used: aspirin (78.9%), beta-blockers (66.5%), statins (81.8%) and ACE-inhibitors (64.4%). The rates of death at 6-month were 20.6% in the obstructive CAD group and 3.1% in the nonobstructive CAD group. The risk reduction of evidence based therapies on 6-month mortality was of greatest magnitude and statistical significance (p<0.0001) in those patients with obstructive CAD (aspirin, hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36-0.63; beta-blocker, HR 0.41, 95% CI 0.31-0.55; statin, HR 0.43, 95% CI 0.33-0.58; ACE-inhibitor, HR 0.46, 95% CI 0.35-0.60). Aspirin, beta-blockers and statins conferred no significant benefits on 6-month mortality in patients with nonobstructive CAD On the opposite ACE-inhibitor was clearly associated with a lower 6-month mortality in these patients (HR 0.66, 95% CI 0.56 to 0.79).
Conclusion: ACE-inhibitor therapy was independently associated with a significant decrease in 6-month mortality in patients with and without obstructive CAD. Patients with nonobstructive CAD showed a greater benefit of ACE-inhibitor therapy than patients with obstructive CAD.
- © 2010 by American Heart Association, Inc.