Cardiovascular Research Institute, Department of Internal Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania, USA.
Am J Cardiol. 2010 Sep 1;106(5):646-9. doi: 10.1016/j.amjcard.2010.04.017.
Agents that block the renin-angiotensin system (RAS), including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, are of proven benefit in patients after ST-segment elevation myocardial infarction (STEMI). However, no studies have evaluated the benefit of pre-event use of RAS inhibitors before STEMI. A retrospective review was performed of patients admitted to a single hospital with the diagnosis of STEMI and without a history of coronary disease or the equivalent, including diabetes mellitus, peripheral vascular disease, or stroke. Patients were stratified according to the use of RAS inhibitors before STEMI. Compared to patients not taking RAS inhibitors, patients who were taking RAS inhibitors had a lower peak troponin I level (79 vs 120 ng/dl, p = 0.016). Of the patients who had medically treated hypertension, those receiving RAS inhibitors had a significantly lower peak troponin I compared to those receiving non-RAS agents (79 vs 130 ng/dl, p = 0.015), despite equivalent blood pressure across the 2 groups. The beneficial effect of RAS inhibitor pretreatment remained when concomitant aspirin and statin use were controlled for. In conclusion, in patients presenting with a first STEMI, pretreatment with RAS inhibitors conferred a cardioprotective effect. The mechanism of this benefit appears to be independent of an effect on blood pressure control and was not wholly due to the effect of concomitant use of other medicines known to be protective in patients with STEMI.
阻断肾素-血管紧张素系统（RAS）的药物，包括血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂，已被证明对 ST 段抬高型心肌梗死（STEMI）患者有益。然而，尚无研究评估过在 STEMI 发生前预先使用 RAS 抑制剂的获益。本研究对单一医院收治的无冠心病病史或相当于冠心病病史（包括糖尿病、外周血管疾病或中风）的 STEMI 患者进行了回顾性分析。患者根据 STEMI 发病前是否使用 RAS 抑制剂进行分层。与未使用 RAS 抑制剂的患者相比，使用 RAS 抑制剂的患者肌钙蛋白 I 峰值水平更低（79 与 120ng/dl，p=0.016）。在接受药物治疗的高血压患者中，与使用非 RAS 药物的患者相比，使用 RAS 抑制剂的患者肌钙蛋白 I 峰值水平显著更低（79 与 130ng/dl，p=0.015），尽管两组患者的血压相当。在控制同时使用阿司匹林和他汀类药物后，RAS 抑制剂预处理的有益效果仍然存在。结论：在首次出现 STEMI 的患者中，预先使用 RAS 抑制剂可产生心脏保护作用。这种获益的机制似乎独立于血压控制的影响，并且不完全归因于同时使用其他已知对 STEMI 患者具有保护作用的药物的影响。
