Centre for Cardiovascular and Lung Biology, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
J Am Coll Cardiol. 2011 Aug 2;58(6):570-6. doi: 10.1016/j.jacc.2011.01.063.
The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS).
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are perceived to be relatively contraindicated in AS. However, inhibitors of the renin-angiotensin system may be beneficial in AS through their cardioprotective and beneficial effects on left ventricular remodeling.
The Health Informatics dispensed prescribing, morbidity, and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database (>110,000 scans). Patients with a diagnosis of AS from 1993 to 2008 were identified. Cox regression model (adjusted for confounding variables) and propensity score analysis were used to assess the impact of ACEIs or ARBs on all-cause mortality and cardiovascular (CV) events (CV death or hospitalizations).
A total of 2,117 patients with AS (mean age 73 ± 12 years, 46% men) were identified and 699 (33%) were on ACEI or ARB therapy. Over a mean follow-up of 4.2 years, there were 1,087 (51%) all-cause deaths and 1,018 (48%) CV events. Those treated with ACEIs or ARBs had a significantly lower all-cause mortality with an adjusted hazard ratio of 0.76 (95% confidence interval: 0.62 to 0.92, p < 0.0001) and fewer CV events with an adjusted hazard ratio of 0.77 (95% confidence interval: 0.65 to 0.92, p < 0.0001). The outcome benefits of ACEIs/ARBs were further supported by propensity score analysis.
This large observational study suggests that ACEI/ARB therapy is associated with an improved survival and a lower risk of CV events in patients with AS.
本研究旨在探讨肾素-血管紧张素系统阻断治疗对主动脉瓣狭窄（AS）结局的影响。
血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）在 AS 中被认为相对禁忌。然而，通过其对左心室重构的心脏保护和有益作用，肾素-血管紧张素系统抑制剂可能对 AS 有益。
通过唯一的患者标识符，将苏格兰泰赛德地区的医疗信息学处方、发病率和死亡率数据库与泰赛德超声心动图数据库（>110,000 次扫描）相关联。从 1993 年到 2008 年，确定了患有 AS 的患者。使用 Cox 回归模型（调整混杂因素）和倾向评分分析评估 ACEI 或 ARB 对全因死亡率和心血管（CV）事件（CV 死亡或住院）的影响。
共确定了 2117 例 AS 患者（平均年龄 73 ± 12 岁，46%为男性），其中 699 例（33%）接受 ACEI 或 ARB 治疗。在平均随访 4.2 年后，共有 1087 例（51%）发生全因死亡和 1018 例（48%）CV 事件。接受 ACEI 或 ARB 治疗的患者全因死亡率显著降低，调整后的危险比为 0.76（95%置信区间：0.62 至 0.92，p<0.0001），CV 事件发生率降低，调整后的危险比为 0.77（95%置信区间：0.65 至 0.92，p<0.0001）。通过倾向评分分析进一步支持 ACEI/ARB 的治疗效果。
这项大型观察性研究表明，ACEI/ARB 治疗与 AS 患者的生存率提高和 CV 事件风险降低相关。
