Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; DREAM-CV Lab, McGill University Health Centre Research Institute, McGill University, Montreal, Quebec, Canada.
Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; DREAM-CV Lab, McGill University Health Centre Research Institute, McGill University, Montreal, Quebec, Canada.
Am Heart J. 2022 May;247:76-89. doi: 10.1016/j.ahj.2022.01.015. Epub 2022 Feb 7.
Renin-angiotensin aldosterone system inhibitors (RAASi) are commonly used among patients hospitalized with a severe acute respiratory syndrome coronavirus 2 infection coronavirus disease 2019 (COVID-19). We evaluated whether continuation versus discontinuation of RAASi were associated with short term clinical or biochemical outcomes.
The RAAS-COVID-19 trial was a randomized, open label study in adult patients previously treated with RAASi who are hospitalized with COVID-19 (NCT04508985). Participants were randomized 1:1 to discontinue or continue RAASi. The primary outcome was a global rank score calculated from baseline to day 7 (or discharge) incorporating clinical events and biomarker changes. Global rank scores were compared between groups using the Wilcoxon test statistic and the negative binomial test (using incident rate ratio [IRR]) and the intention-to-treat principle.
Overall, 46 participants were enrolled; 21 participants were randomized to discontinue RAASi and 25 to continue. Patients' mean age was 71.5 years and 43.5% were female. Discontinuation of RAASi, versus continuation, resulted in a non-statistically different mean global rank score (discontinuation 6 [standard deviation [SD] 6.3] vs continuation 3.8 (SD 2.5); P = .60). The negative binomial analysis identified that discontinuation increased the risk of adverse outcomes (IRR 1.67 [95% CI 1.06-2.62]; P = .027); RAASi discontinuation increased brain natriuretic peptide levels (% change from baseline: +16.7% vs -27.5%; P = .024) and the incidence of acute heart failure (33% vs 4.2%, P = .016).
RAASi continuation in participants hospitalized with COVID-19 appears safe; discontinuation increased brain natriuretic peptide levels and may increase risk of acute heart failure; where possible, RAASi should be continued.
肾素-血管紧张素-醛固酮系统抑制剂（RAASi）在因严重急性呼吸系统综合征冠状病毒 2 感染导致的 2019 年冠状病毒病（COVID-19）而住院的患者中通常被使用。我们评估了继续或停止使用 RAASi 是否与短期临床或生化结局相关。
RAAS-COVID-19 试验是一项随机、开放标签研究，纳入了此前接受 RAASi 治疗且因 COVID-19 住院的成年患者（NCT04508985）。参与者按 1:1 随机分为停止或继续 RAASi 组。主要结局是从基线到第 7 天（或出院）的综合临床事件和生物标志物变化的全球等级评分。使用 Wilcoxon 检验统计量和负二项检验（使用发病率比[IRR]）以及意向治疗原则对两组之间的全球等级评分进行比较。
共有 46 名参与者入组；21 名参与者被随机分配停止使用 RAASi，25 名继续使用。患者的平均年龄为 71.5 岁，43.5%为女性。与继续使用相比，停止使用 RAASi 导致的平均全球等级评分无统计学差异（停止使用 6[标准差[SD]6.3] vs 继续使用 3.8[SD 2.5]；P=0.60）。负二项分析表明，停止使用增加了不良结局的风险（IRR 1.67[95%CI 1.06-2.62]；P=0.027）；RAASi 停止使用增加了脑钠肽水平（与基线相比的百分比变化：+16.7% vs -27.5%；P=0.024）和急性心力衰竭的发生率（33% vs 4.2%，P=0.016）。
在因 COVID-19 住院的患者中继续使用 RAASi 似乎是安全的；停止使用会增加脑钠肽水平，并可能增加急性心力衰竭的风险；在可能的情况下，应继续使用 RAASi。
