Effects of Angiotensin-Converting Enzyme Inhibitors/Angiotensin II Receptor Blockers on Prognosis in Acute Coronary Syndrome Patients with Preserved Ejection Fraction Undergoing Regular Dialysis.

Purpose: The utilization of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) following myocardial infarction (MI) is substantiated by evidence derived from trials conducted during the thrombolysis era. However, limited evidence suggests that ACEI/ARB confer benefits to patients with preserved left ventricular ejection fraction (LVEF). Notably, these studies typically exclude patients undergoing regular dialysis. In this study, we examined the association between the use of ACEI/ARB and the 5-year outcomes in patients with acute coronary syndrome (ACS) who are on regular dialysis and possess preserved left ventricular function.

Methods: This multicenter retrospective study enrolled a total of 1249 dialysis patients diagnosed with coronary heart disease (CAD). A total of 603 patients meeting the inclusion and exclusion criteria were analyzed.

Results: The mean age of the cohort was 61.7 years, with 70.6% being male; 313 (51.9%) patients were treated with ACEI/ARB. Over a 5-year follow-up period, the use of ACEI/ARB had no benefit on the composite outcome of major adverse cardiovascular events (MACE) (31.3% vs. 29.0%, p = 0.988). However, ACEI/ARBs reduced mortality across all causes (24.9% vs. 33.1%, p = 0.012) and cardiovascular deaths (14.7% vs. 21.4%, p = 0.015). Furthermore, ACEI/ARB demonstrated a more pronounced cardiovascular mortality benefit in patients with poorer left ventricular function (LVEF 50-60%).

Conclusion: In dialysis patients with ACS and preserved left ventricular function, ACEI/ARB reduces all-cause and cardiovascular mortality. Additionally, a more pronounced survival benefit is observed in patients with impaired LVEF (50-60%). However, no benefit was found regarding MACE.