Effects of angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor blocker on one-year outcomes of patients with atrial fibrillation: insights from a multicenter registry study in China

作者：Si-Qi LYU; Yan-Min YANG; Jun ZHU; Juan WANG; Shuang WU; Jia-Meng REN; Han ZHANG; Xing-Hui SHAO

来源：Journal of Geriatric Cardiology, 2020, 17(12): 750-758.

Objective To evaluate the effect of angiotensin-converting enzyme inhibitor(ACEI)/angiotensin II receptor blocker(ARB) therapy on the prognosis of patients with atrial fibrillation(AF). Methods A total of 1,991 AF patients from the AF registry were divided into two groups according to whether they were treated with ACEI/ARB at recruitment. Baseline characteristics were carefully collected and analyzed. Logistic regression was utilized to identify the predictors of ACEI/ARB therapy. The primary endpoint was all-cause mortality, while the secondary endpoints included cardiovascular mortality, stroke and major adverse events(MAEs) during the one-year follow-up period. Univariable and multivariable Cox regression were performed to identify the association between ACEI/ARB therapy and the one-year outcomes. Results In total, 759 AF patients(38.1%) were treated with ACEI/ARB. Compared with AF patients without ACEI/ARB therapy, patients treated with ACEI/ARB tended to be older and had a higher rate of permanent AF, hypertension, diabetes mellitus, heart failure(HF), left ventricular ejection fraction(LVEF) < 40%, coronary artery disease(CAD), prior myocardial infarction(MI), left ventricular hypertrophy, tobacco use and concomitant medications(all P < 0.05). Hypertension, HF, LVEF < 40%, CAD, prior MI and tobacco use were determined to be predictors of ACEI/ARB treatment. Multivariable analysis showed that ACEI/ARB therapy was associated with a significantly lower risk of one-year all-cause mortality [hazard ratio(HR)(95% CI): 0.682(0.527–0.882), P = 0.003], cardiovascular mortality [HR(95% CI): 0.713(0.514–0.988), P = 0.042] and MAEs [HR(95% CI): 0.698(0.568–0.859), P = 0.001]. The association between ACEI/ARB therapy and reduced mortality was consistent in the subgroup analysis. Conclusions In patients with AF, ACEI/ARB was related to significantly reduced one-year all-cause mortality, cardiovascular mortality and MAEs despite the high burden of cardiovascular comorbidities.

• 单位
  心血管疾病国家重点实验室; 北京协和医学院; 中国医学科学院北京协和医院