Department of Cardiology, Kameda Medical Center, Chiba, Japan.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Am J Cardiovasc Drugs. 2019 Dec;19(6):597-605. doi: 10.1007/s40256-019-00355-3.
Although angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been recommended for patients with heart failure, their clinical and prognostic impact in the very acute phase of acute heart failure (AHF) is unclear, mainly because data on their safety and efficacy are lacking.
This study was a post hoc analysis of the REALITY-AHF trial. Patients with AHF who did not take an ACEI or ARB at admission were enrolled. Patients who received these medications within 48 h of admission were categorized as the ACEI/ARB group, and all other patients were categorized as the no ACEI/ARB group. The primary endpoint was a composite of all-cause death and heart failure readmission within 1 year of admission.
Of the 1682 patients in the REALITY-AHF cohort, 900 were enrolled in this study, and 288 (32%) were included in the ACEI/ARB group. After propensity score matching, 152 pairs were evaluated, and no significant difference was found for in-hospital mortality, worsening renal function, or length of hospital stay. The ACEI/ARB group had significantly higher event-free survival (hazard ratio 0.51; 95% confidence interval 0.32-0.82; p = 0.006).
Early initiation of ACEIs/ARBs within 48 h of admission for hospitalized patients with AHF was not associated with adverse events and correlated with improved outcomes at 1 year from admission.
尽管血管紧张素转换酶抑制剂（ACEI）和血管紧张素 II 受体阻滞剂（ARB）已被推荐用于心力衰竭患者，但它们在急性心力衰竭（AHF）的极急性期的临床和预后影响尚不清楚，主要是因为缺乏关于它们的安全性和疗效的数据。
本研究是 REALITY-AHF 试验的事后分析。纳入入院时未服用 ACEI 或 ARB 的 AHF 患者。入院后 48 小时内使用这些药物的患者被归类为 ACEI/ARB 组，所有其他患者被归类为无 ACEI/ARB 组。主要终点是入院后 1 年内全因死亡和心力衰竭再入院的复合终点。
REALITY-AHF 队列中的 1682 例患者中，有 900 例被纳入本研究，其中 288 例（32%）被纳入 ACEI/ARB 组。经过倾向评分匹配后，评估了 152 对患者，住院期间死亡率、肾功能恶化或住院时间无显著差异。ACEI/ARB 组无事件生存显著更高（风险比 0.51；95%置信区间 0.32-0.82；p=0.006）。
AHF 住院患者入院后 48 小时内早期开始使用 ACEI/ARB 与不良事件无关，并与入院后 1 年的预后改善相关。
