Høgh Annette, Lindholt Jes S, Nielsen Henrik, Jensen Leif P, Johnsen Søren P
Department of Vascular Surgery, Regionshospitalet, Viborg, Denmark.
Vasc Endovascular Surg. 2012 Oct;46(7):515-23. doi: 10.1177/1538574412455229. Epub 2012 Jul 27.
To examine the association between angiotensin-converting enzyme (ACE) inhibitor use and clinical outcome after primary vascular reconstruction in a population-based follow-up study.
All Danish patients undergoing primary vascular surgical reconstruction between 1996 and 2007 were included. For each ACE user up to 5 nonuser was identified using propensity score matching followed by Cox regression. All drugs were included as time-dependent variables.
Totally 17 495 matched patients with a median follow-up period of 582 days were included. All-cause mortality was 20.4% for ACE users and 24.9% for nonusers (adjusted hazard ratio [adj HR] 0.88, 95% confidence interval [CI] 0.81-0.96). The cumulative risk of myocardial infarction was 6.2% for ACE users and 4.7% for nonusers (adj HR 1.20, 95%CI 1.03-1.39). Cumulative risk of new vascular surgery was 24.0% for ACE users and 23.1% for nonusers (adj HR 1.21, 95% CI 1.13-1.30). No differences were seen concerning stroke and major amputation.
The ACE use was associated with lower all-cause mortality but also an increased long-term risk of recurrent vascular reconstruction.
在一项基于人群的随访研究中，探讨血管紧张素转换酶（ACE）抑制剂的使用与初次血管重建术后临床结局之间的关联。
纳入1996年至2007年间接受初次血管外科重建的所有丹麦患者。对于每一位使用ACE抑制剂的患者，通过倾向评分匹配法确定多达5名未使用者，随后进行Cox回归分析。所有药物均作为时间依赖性变量纳入分析。
共纳入17495例匹配患者，中位随访期为582天。ACE抑制剂使用者的全因死亡率为20.4%，未使用者为24.9%（校正风险比[adj HR]为0.88，95%置信区间[CI]为0.81 - 0.96）。ACE抑制剂使用者心肌梗死的累积风险为6.2%，未使用者为4.7%（adj HR为1.20，95%CI为1.03 - 1.39）。ACE抑制剂使用者再次进行血管手术的累积风险为24.0%，未使用者为23.1%（adj HR为1.21，95%CI为1.13 - 1.30）。在中风和大截肢方面未观察到差异。
使用ACE抑制剂与较低的全因死亡率相关，但也增加了血管重建复发的长期风险。
