Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention
Introduction: The long-term impact of renin-angiotensin system (RAS) inhibitors for secondary prevention in patients with chronic kidney disease (CKD) and coexisting coronary artery disease remains unclear. Methods: Altogether, 1,160 consecutive patients with CKD (mean age, 70 ± 9 years; 78% men) wh...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Karger Publishers
2023-10-01
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| Series: | Kidney Diseases |
| Subjects: | |
| Online Access: | https://beta.karger.com/Article/FullText/532055 |
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| author | Tatsuya Fukase Tomotaka Dohi Ryota Nishio Mitsuhiro Takeuchi Norihito Takahashi Yuichi Chikata Hirohisa Endo Shinichiro Doi Hiroki Nishiyama Iwao Okai Hiroshi Iwata Shinya Okazaki Katsumi Miyauchi Hiroyuki Daida Tohru Minamino |
| author_facet | Tatsuya Fukase Tomotaka Dohi Ryota Nishio Mitsuhiro Takeuchi Norihito Takahashi Yuichi Chikata Hirohisa Endo Shinichiro Doi Hiroki Nishiyama Iwao Okai Hiroshi Iwata Shinya Okazaki Katsumi Miyauchi Hiroyuki Daida Tohru Minamino |
| author_sort | Tatsuya Fukase |
| collection | DOAJ |
| description | Introduction: The long-term impact of renin-angiotensin system (RAS) inhibitors for secondary prevention in patients with chronic kidney disease (CKD) and coexisting coronary artery disease remains unclear. Methods: Altogether, 1,160 consecutive patients with CKD (mean age, 70 ± 9 years; 78% men) who underwent their first percutaneous coronary intervention (PCI) between 2000 and 2018 were included and analyzed. Based on their RAS inhibitor use, 674 patients (58%) were allocated to the RAS inhibitor group, and 486 patients (42%) were allocated to the non-RAS inhibitor group. This study evaluated the incidence of 3-point major adverse cardiovascular events (3P-MACE), including cardiovascular death, nonfatal acute coronary syndrome and nonfatal stroke, admission for heart failure (HF), target vessel revascularization (TVR), and all-cause death. Results: During a median follow-up duration of 7.8 years, 280 patients (24.1%) developed 3P-MACE, 134 patients (11.6%) were hospitalized for HF, 171 patients (14.7%) underwent TVR, and 348 patients (30.0%) died of any causes. The cumulative incidence rate of 3P-MACE in the RAS inhibitor group was significantly lower than in the non-RAS inhibitor group (31.7% vs. 39.0%, log-rank test, p = 0.034); however, that of admission for HF in the RAS inhibitor group was significantly higher than in the non-RAS inhibitor group (28.1% vs. 13.3%, log-rank test, p < 0.001). The subgroup of preserved ejection fraction, non-acute myocardial infarction, and non-proteinuria tended to promote the onset of HF rather than cardiovascular prevention by RAS inhibitors. Conclusion: The long-term RAS inhibitor use for patients with CKD after PCI might prevent cardiovascular events but increase the risk of HF. |
| first_indexed | 2024-03-11T11:45:37Z |
| format | Article |
| id | doaj.art-7897d6927f9647b3951ccb84fbc06e28 |
| institution | Directory Open Access Journal |
| issn | 2296-9357 |
| language | English |
| last_indexed | 2024-03-11T11:45:37Z |
| publishDate | 2023-10-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Kidney Diseases |
| spelling | doaj.art-7897d6927f9647b3951ccb84fbc06e282023-11-09T13:57:54ZengKarger PublishersKidney Diseases2296-93572023-10-0111210.1159/000532055532055Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary InterventionTatsuya Fukase0Tomotaka Dohi1Ryota Nishio2Mitsuhiro Takeuchi3Norihito Takahashi4Yuichi Chikata5Hirohisa Endo6Shinichiro Doi7Hiroki Nishiyama8Iwao Okai9Hiroshi Iwata10Shinya Okazaki11Katsumi Miyauchi12Hiroyuki Daida13Tohru Minamino14Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanIntroduction: The long-term impact of renin-angiotensin system (RAS) inhibitors for secondary prevention in patients with chronic kidney disease (CKD) and coexisting coronary artery disease remains unclear. Methods: Altogether, 1,160 consecutive patients with CKD (mean age, 70 ± 9 years; 78% men) who underwent their first percutaneous coronary intervention (PCI) between 2000 and 2018 were included and analyzed. Based on their RAS inhibitor use, 674 patients (58%) were allocated to the RAS inhibitor group, and 486 patients (42%) were allocated to the non-RAS inhibitor group. This study evaluated the incidence of 3-point major adverse cardiovascular events (3P-MACE), including cardiovascular death, nonfatal acute coronary syndrome and nonfatal stroke, admission for heart failure (HF), target vessel revascularization (TVR), and all-cause death. Results: During a median follow-up duration of 7.8 years, 280 patients (24.1%) developed 3P-MACE, 134 patients (11.6%) were hospitalized for HF, 171 patients (14.7%) underwent TVR, and 348 patients (30.0%) died of any causes. The cumulative incidence rate of 3P-MACE in the RAS inhibitor group was significantly lower than in the non-RAS inhibitor group (31.7% vs. 39.0%, log-rank test, p = 0.034); however, that of admission for HF in the RAS inhibitor group was significantly higher than in the non-RAS inhibitor group (28.1% vs. 13.3%, log-rank test, p < 0.001). The subgroup of preserved ejection fraction, non-acute myocardial infarction, and non-proteinuria tended to promote the onset of HF rather than cardiovascular prevention by RAS inhibitors. Conclusion: The long-term RAS inhibitor use for patients with CKD after PCI might prevent cardiovascular events but increase the risk of HF.https://beta.karger.com/Article/FullText/532055renin-angiotensin system inhibitorchronic kidney diseaseheart failurecardiovascular eventspercutaneous coronary intervention |
| spellingShingle | Tatsuya Fukase Tomotaka Dohi Ryota Nishio Mitsuhiro Takeuchi Norihito Takahashi Yuichi Chikata Hirohisa Endo Shinichiro Doi Hiroki Nishiyama Iwao Okai Hiroshi Iwata Shinya Okazaki Katsumi Miyauchi Hiroyuki Daida Tohru Minamino Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention Kidney Diseases renin-angiotensin system inhibitor chronic kidney disease heart failure cardiovascular events percutaneous coronary intervention |
| title | Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention |
| title_full | Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention |
| title_fullStr | Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention |
| title_full_unstemmed | Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention |
| title_short | Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention |
| title_sort | long term impact of renin angiotensin system inhibitors for secondary prevention in patients with chronic kidney disease who underwent percutaneous coronary intervention |
| topic | renin-angiotensin system inhibitor chronic kidney disease heart failure cardiovascular events percutaneous coronary intervention |
| url | https://beta.karger.com/Article/FullText/532055 |
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