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 m2, 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 m2 and with neutral effect in those with GFR <30 ml/min/1.73 m2.
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Article info
Publication history
Published online: January 16, 2015
Accepted:
January 3,
2015
Received in revised form:
January 3,
2015
Received:
November 17,
2014
Footnotes
Drs. AlJaroudi and Refaat contributed equally.
This study was supported by a research grant #R01 HL77398 from the National Heart, Lung, and Blood Institute.
Trial Registration: ClinicalTrials.gov (NCT02045043).
See page 931 for disclosure information.
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
