We sought to determine the effectiveness of angiotensin-converting enzyme (ACE) inhibition
and β-blocker treatment as a function of the degree of coronary artery disease (CAD)
obstruction at angiography. The Evaluation of Methods and Management of Acute Coronary
Events registry enrolled patients who had been hospitalized for an acute coronary
syndrome. There were 1,602 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. The cohort consisted of
1,252 patients with obstructive CAD (>50% luminal diameter obstructed) and 350 patients
with nonobstructive CAD. Multivariate logistic regression analysis adjusted for further
medications and other clinical factors was performed. Patients with nonobstructive
CAD had significantly (p <0.001) higher rates of β-blocker (77.8% vs 63.3%) and lower
rates of ACE-inhibitor (57.7% vs 66.4%) prescriptions. In patients with nonobstructive
CAD, ACE-inhibitor therapy was clearly associated with a lower 6-month mortality (odds
ratio [OR] 0.31, 95% confidence interval [CI] 0.03 to 0.78, p = 0.004). No significant
association between β-blocker use and death was found. In patients with obstructive
CAD, both β blockers (OR 0.47, 95% CI 0.32 to 0.67, p <0.001) and ACE inhibitors (OR
0.47, 95% CI 0.26 to 0.87, p = 0.01) were significantly associated with a reduced
risk of 6-month mortality. In conclusion, ACE-inhibitor therapy seems to be an effective
first-line treatment for preventing the occurrence of mortality in patients with nonobstructive
CAD
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Article info
Publication history
Published online: March 05, 2014
Accepted:
February 24,
2014
Received in revised form:
February 24,
2014
Received:
January 8,
2014
Footnotes
See page 1632 for disclosure information.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
