Clinical Pharmacy Program, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.
J Cardiovasc Pharmacol Ther. 2010 Sep;15(3):274-81. doi: 10.1177/1074248410373751. Epub 2010 Jul 12.
Angiotensin-converting enzyme inhibitors (ACEIs) have shown promising results in decreasing the incidence and the severity of ischemic stroke in populations at risk and in improving ischemic stroke outcomes.
The objectives of this study were to investigate the impact of ACEI use before ischemic stroke onset on in-hospital mortality and to identify the independent predictors of in-hospital mortality among patients with ischemic stroke.
A retrospective cohort study of all patients with acute ischemic stroke attending the hospital from June 1, 2008 to November 30, 2008 was performed. Data were collected from medical records and included demographic information, diagnostic information, risk factors, previous ACEI use, and vital discharge status. Statistical Package for Social Sciences (SPSS) version 15 was used for data analysis.
A total of 327 patients with acute ischemic stroke were studied, of which 119 (36.4%) had documented previous ACEI use. During the study period, 52 (15.9%) of the patients with acute ischemic stroke died in hospital. In-hospital mortality was significantly lower among patients who were on ACEI before the attack (P = 0.002). The independent predictors for in-hospital mortality among patients with ischemic stroke were age >or=65 years (P < .001), the presence of diabetes mellitus (P = .012), renal impairment (P = .002), and heart failure (P = .001). Moreover, prior use of ACEI was an independent predictor for survival after ischemic stroke attack (P < .001).
This study provides evidence that the prophylactic administration of ACEI before ischemic stroke may be a potential life-saving strategy. Furthermore, knowledge of in-hospital mortality predictors is necessary to improve survival rate after acute stroke.
血管紧张素转换酶抑制剂（ACEI）已显示出在降低风险人群中缺血性卒中的发生率和严重程度以及改善缺血性卒中结局方面的前景。
本研究旨在探讨缺血性卒中发病前使用 ACEI 对住院死亡率的影响，并确定缺血性卒中患者住院死亡率的独立预测因素。
对 2008 年 6 月 1 日至 2008 年 11 月 30 日期间在我院就诊的所有急性缺血性卒中患者进行了回顾性队列研究。从病历中收集数据，包括人口统计学信息、诊断信息、危险因素、既往 ACEI 使用情况和生命出院状态。使用社会科学统计软件包（SPSS）版本 15 进行数据分析。
共研究了 327 例急性缺血性卒中患者，其中 119 例（36.4%）有记录的既往 ACEI 使用情况。在研究期间，52 例（15.9%）急性缺血性卒中患者在院内死亡。在发病前使用 ACEI 的患者中，院内死亡率明显较低（P=0.002）。缺血性卒中患者院内死亡的独立预测因素为年龄≥65 岁（P<0.001）、糖尿病（P=0.012）、肾功能不全（P=0.002）和心力衰竭（P=0.001）。此外，缺血性卒中发病前使用 ACEI 是生存的独立预测因素（P<0.001）。
本研究提供的证据表明，缺血性卒中发病前预防性使用 ACEI 可能是一种潜在的救生策略。此外，了解住院死亡率的预测因素对于提高急性卒中后的生存率是必要的。
