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Effect of angiotensin-converting enzyme inhibitors and receptor blockers on appropriate implantable cardiac defibrillator shock in patients with severe systolic heart failure (from the GRADE Multicenter Study)
Journal article   Open access   Peer reviewed

Effect of angiotensin-converting enzyme inhibitors and receptor blockers on appropriate implantable cardiac defibrillator shock in patients with severe systolic heart failure (from the GRADE Multicenter Study)

Wael A AlJaroudi, Marwan M Refaat, Robert H Habib, Laila Al-Shaar, Madhurmeet Singh, Rebecca Gutmann, Heather L Bloom, Samuel C Dudley, Patrick T Ellinor, Samir F Saba, …
The American journal of cardiology, Vol.115(7), pp.924-931
04/01/2015
DOI: 10.1016/j.amjcard.2015.01.020
PMCID: PMC4363172
PMID: 25682436
url
http://doi.org/10.1016/j.amjcard.2015.01.020View
Open Access

Abstract

Sudden cardiac death (SCD) is a leading cause of mortality in patients with cardiomyopathy. Although angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) decrease cardiac mortality in these cohorts, their role in preventing SCD has not been well established. We sought to determine whether the use of ACEi or ARB in patients with cardiomyopathy is associated with a lower incidence of appropriate implantable cardiac defibrillator (ICD) shocks in the Genetic Risk Assessment of Defibrillator Events study that included subjects with an ejection fraction of ≤30% and ICDs. Treatment with ACEi/ARB versus no-ACEi/ARB was physician dependent. There were 1,509 patients (mean age [SD] 63 [12] years, 80% men, mean [SD] EF 21% [6%]) with 1,213 (80%) on ACEi/ARB and 296 (20%) not on ACEi/ARB. We identified 574 propensity-matched patients (287 in each group). After a mean (SD) of 2.5 (1.9) years, there were 334 (22%) appropriate shocks in the entire cohort. The use of ACEi/ARB was associated with lower incidence of shocks at 1, 3, and 5 years in the matched cohort (7.7%, 16.7%, and 18.5% vs 13.2%, 27.5%, and 32.0%; RR = 0.61 [0.43 to 0.86]; p = 0.005). Among patients with glomerular filtration rate (GFR) >60 and 30 to 60 ml/min/1.73 m(2), those on no-ACEi/ARB were at 45% and 77% increased risk of ICD shock compared with those on ACEi/ARB, respectively. ACEi/ARB were associated with significant lower incidence of appropriate ICD shock in patients with cardiomyopathy and GFR ≥30 ml/min/1.73 m(2) and with neutral effect in those with GFR <30 ml/min/1.73 m(2).
 Severity of Illness Index Risk Assessment - methods United States - epidemiology Prospective Studies Survival Rate - trends Follow-Up Studies Death, Sudden, Cardiac - epidemiology Heart Failure, Systolic - mortality Heart Failure, Systolic - therapy Humans Middle Aged Risk Factors Death, Sudden, Cardiac - prevention & control Male Angiotensin-Converting Enzyme Inhibitors - therapeutic use Time Factors Heart Failure, Systolic - physiopathology Female Aged Angiotensin Receptor Antagonists - therapeutic use

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