Abstract 11917: Angiotensin-Converting Enzyme Inhibitors are not Associated With Increased Sudden Cardiac Death, Cardiovascular Mortality or All-cause Mortality In Patients With Mild to Moderate Aortic Stenosis - The SEAS Study
Objectives: Evaluate if angiotensin-converting enzyme inhibitors (ACEI) are well tolerated in patients with mild to moderate aortic stenosis (AS).
Background: ACEI are avoided in AS patients because of the risk of hypotension.
Methods: From the Simvastatin Ezetimibe in Aortic Stenosis study patients with asymptomatic mild to moderate AS (transaortic Doppler velocity 2.5 and 4.0 m/sec) and preserved LV ejection fraction (EF) were included. Risks of hypotension (systolic bloodpressure<90mmHg), sudden cardiac death, cardiovascular mortality and all-cause mortality and according to ACEI use were analyzed by time-varying Cox models adjusted for age, gender, other medication and comorbidity, and additionally in propensity score matched analysis.
Results: 1873 patients (mean age was 68±10years) were analyzed, including 368 (19.6%) patients receiving ACEI. At baseline treated patients had higher systolic blood pressure (148±20.2 vs. 144±19.8mmHg) and LV mass index (106±34.4 vs. 99±29.6g/m2) than the non-treated, but there was no difference in gender, age, aortic valve area or simvastatin/ezetimibe treatment. During a median follow-up of 52.2 months, there were 2.4% vs. 2.1% sudden cardiac deaths, 7.6% vs. 5.0% cardiovascular deaths and 9.5% vs. 11.3% all-cause deaths in the patients receiving vs. not receiving ACEI. Only 6 patients had in-study hypotension. The multivariable time-varying Cox analysis showed no increase in the risk of sudden cardiac death (HR: 1.47 [95%CI: 0.43-5.07], p=0.538), cardiovascular mortality (HR: 2.03 [95%CI: 0.78-3.28], p=0.203) or all-cause mortality (HR: 1.06 [95%CI: 0.58-1.94], p=0.857, Figure) among ACEI treated. These outcomes were supported in propensity matched analysis (All p>0.05).
Conclusions: Angiotensin-converting enzyme inhibitors were not associated with increased risk of sudden cardiac death, cardiovascular mortality or all-cause mortality in patients with asymptomatic mild to moderate AS.
- © 2012 by American Heart Association, Inc.