Abstract 17233: The Preventive Effect of Angiotensin-converting Enzyme Inhibitor on Renal Function in the Late Phase After Percutaneous Coronary Intervention in Patients With Statin
Introduction: The statin is a pivotal medicine for patients with angina pectoris, and is thought to have a preventive effect on renal function. Depressant medicines of Renin-Angiotensin System (RAS) medicines are also used to treat chronic kidney disease. However, the impact of anti-RAS medication on renal function in the late phase after percutaneous coronary intervention (PCI) are unknown.The purpose of this study was to investigate the effect of anti-RAS medicines on renal function in late phase after PCI in patients with statin.
Methods: In 151 consecutive patients treated with statin before PCI, serum creatinine (Cr) and serum Cystatin C (CysC) were evaluated at index PCI (baseline) and at 9 months after PCI, and the percent changes in Cre (%Cr) and CysC (%CysC) were calculated. The association between anti-RAS medicines and %Cr or %CysC were assessed. The worsening renal function (WRF) after PCI was defined as %CysC≥1.5 (CysC-WRF) or %Cr≥1.5 (Cr-WRF).
Results: Of 151 patients, 72 patients had WRF according to %CysC≥1.5. On the other hand, 89 patients had WRF based on %Cre≥1.5. Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) were prescribed in 39 (26%) and 72 (48%) patients, respectively. There were no patients who were taking both ACEI and ARB. Only the use of ACEI was significantly different between CysC-WRF and non-CysC-WRF patients (14 vs. 37%, p=0.001). Similarly, the rate of ACEI use in Cr-WRF patients was lower than that in non-Cr-WRF patients (15 vs. 42%, p<0.001). In univariate analysis, the use of ACEI was negatively associated with SysC-WRF [Odds ratio (OR)=0.28, 95% confidence interval (CI)=0.12-0.61, p=0.001], which means ACEI prevented the renal function in the late phase after PCI. The same result was also indicated by Cr-WRF (OR=0.24, 95% CI=0.11-0.51, p<0.001). The multivariate analysis revealed that the use of ACEI was significantly correlated with CysC-WRF or Cr-WRF (OR=0.32, 95% CI=0.12-0.83, p=0.021 or OR=0.21, 95% CI=0.09 - 0.46, p<0.001, respectively). In contrast, ARB didn’t correlate with them.
Conclusions: In patients with statin, ACEI and ARB had different impact on renal function. Only ACEI may have preventive effect on WRF in the late phase after PCI in patients with statin.
Author Disclosures: D. Kanda: None. T. Takumi: None. T. Sonoda: None. I. Kosedo: None. M. Miyata: None. M. Ohishi: None.
- © 2016 by American Heart Association, Inc.