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2009 Southern Regional Meeting Abstracts
Session: Cardiovascular Club
PROTECTIVE ROLE OF CHRONIC ANGIOTENSIN CONVERTING ENZYME INHIBITOR (ACEI) THERAPY IN REDUCING PERI-PROCEDURAL MYOCARDIAL INFARCTION IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION
Bansal D1,2, Aleti S1,2, Sukhija R1,2, Muppidi R1,2, Mehta J1,2, Sachdeva R1,2. 1Central Arkansas Veterans Healthcare Administration, Little Rock, AR and 2University of Arkansas for Medical Sciences, Little Rock, AR.
Purpose of Study: Peri-procedural myocardial infarction (MI) is a frequent complication of Percutaneous Coronary Intervention (PCI). Studies have shown that Angiotensin Converting Enzyme Inhibitors (ACEI) may improve endothelial function and may reduce ischemia-reperfusion myocardial injury. The study objective was to verify whether chronic treatment with ACEI reduces the occurrence of peri-procedural MI in patients undergoing PCI.
Methods Used: Study cohort was formed by all patients who had PCI done during January 2003 to August 2004 at one institution. Data were obtained on a total of 481 interventions of which 230 were done on patients on chronic ACEI therapy
Summary of Results: ACEI-treated patients had a higher prevalence of hypertension and diabetes. The incidence of peri-procedural MI was lower (6% vs. 13% , P value 0.014) among patients on chronic ACEI therapy. Incidence of contrast induced nephropathy was similar. Predictors of periprocedural MI are as shown in Table 1. Multiple logistic regression model including age, risk factors, pre-procedural medications and procedural characteristics like type of stent, glycoprotein IIb/IIIa inhibitor use identified pre-procedural chronic ACEI therapy as the only independent negative predictor of peri-procedural MI (odds ratio = 0.32; 95% confidence intervals 0.15-0.72; P = 0.005).
Conclusions: Chronic therapy with ACEI reduces the incidence of periprocedural MI among patients undergoing PCI. This beneficial effect was independent of clinical and angiographic characteristics and the use of other cardiovascular drugs including statins and beta-blockers.
Table 1. Predictors of peri-procedural myocardial infarction
| Periprocedural MI (n= 45) | No periprocedural MI (n=407) | P Value | | Age (yrs) | 66 ± 10 | 62 ± 10 | 0.26 | | Hypertension | 31 (70%) | 292 (72%) | 0.68 | | Hyperlipidemia | 28 (62%) | 254 (62%) | 0.98 | | Diabetes Mellitus | 17 (38%) | 113 (28%) | 0.16 | | ACE inhibitors | 13 (29%) | 196 (48%) | 0.014 | | Beta- blockers | 26 (60%) | 235 (58%) | 0.74 | | Oral hypoglycemics | 13 (30%) | 74 (18%) | 0.06 | | Statins | 28(62%) | 279 (69%) | 0.38 |
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