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Prognostic impact of angiotensin-converting enzyme inhibitors and receptor blockers on recurrent ventricular tachyarrhythmias and implantable cardioverter-defibrillator therapies

Abstract: This study sought to assess the prognostic impact of treatment with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) on recurrences of ventricular tachyarrhythmias in recipients of implantable cardioverter-defibrillators (ICD). Using a large retrospect...

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Main Authors: Schupp, Tobias (Author) , Behnes, Michael (Author) , Weiß, Christel (Author) , Lang, Siegfried (Author) , Akın, Ibrahim (Author) , Reiser, Linda (Author) , Kern-Bollow, Armin (Author) , Taton, Gabriel (Author) , Reichelt, Thomas (Author) , Ellguth, Dominik (Author) , Engelke, Niko (Author) , Borggrefe, Martin (Author)
Format: Article (Journal)
Language:English
Published: May 2019
In: Journal of cardiovascular pharmacology
Year: 2019, Volume: 73, Issue: 5, Pages: 272-281
ISSN:1533-4023
DOI:10.1097/FJC.0000000000000659
Online Access:Verlag, Volltext: https://doi.org/10.1097/FJC.0000000000000659
Verlag, Volltext: https://journals.lww.com/cardiovascularpharm/Abstract/2019/05000/Prognostic_Impact_of_Angiotensin_Converting_Enzyme.2.aspx
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Author Notes:Tobias Schupp, Michael Behnes, Christel Weiß, Christoph Nienaber, Siegfried Lang, Linda Reiser, Armin Bollow, Gabriel Taton, Thomas Reichelt, Dominik Ellguth, Niko Engelke, Thomas Bertsch, Muharrem Akin, Kambis Mashayekhi, Martin Borggrefe, Ibrahim Akin
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Summary:Abstract: This study sought to assess the prognostic impact of treatment with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) on recurrences of ventricular tachyarrhythmias in recipients of implantable cardioverter-defibrillators (ICD). Using a large retrospective registry including consecutive ICD recipients with documented episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016, those patients treated with ACEi/ARB were compared with patients without. The primary prognostic endpoint was the first recurrence of ventricular tachyarrhythmias and related ICD therapies at 5 years. Multivariable Cox regression analyses were applied within the entire cohort, and thereafter, Kaplan-Meier analyses were performed in propensity-matched subgroups. A total of 592 consecutive ICD recipients were included (81% treated with ACEi/ARB and 19% without). Although ACEi/ARB was associated with no differences in overall recurrence of ventricular tachyarrhythmias, ACEi/ARB was associated with improved freedom from appropriate ICD therapy within multivariable Cox regressions (hazard ratio = 0.666; P = 0.043), especially in patients with index episodes of VF, left ventricular ejection fraction <35%, coronary artery disease, secondary preventive ICD, and glomerular filtration rate <45 mL/min/1.73 m2. In the propensity-matched subgroup, ACEi/ARB still prolonged freedom from appropriate ICD therapies (hazard ratio = 0.380; 95% confidence interval 0.193-0.747; P = 0.005). In conclusion, ACEi/ARB therapy was associated with improved freedom from appropriate ICD therapies.
Item Description:Gesehen am 24.02.2020
Physical Description:Online Resource
ISSN:1533-4023
DOI:10.1097/FJC.0000000000000659

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