Effect of angiotensin converting enzyme inhibitors on periprocedural myocardial infarction in patients with metabolic syndrome

• Published in: Cardiology journal 2015, Vol.22 (3), p.323-329
• Main Authors: Ozcan, Ozgur Ulas, Ustun, Elif Ezgi, Gulec, Sadi, Gerede, Demet Menekse, Goksuluk, Huseyin, Vurgun, Veysel Kutay, Kaya, Cansin Tulunay, Erol, Cetin
• Format: Article
• Language: English
• Subjects: Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biomarkers - blood; Body mass index; Chi-Square Distribution; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Coronary Artery Disease - therapy; Creatine Kinase, MB Form - blood; Enzymes; Female; Heart attacks; Humans; Incidence; Logistic Models; Male; Metabolic syndrome; Metabolic Syndrome - diagnosis; Metabolic Syndrome - drug therapy; Metabolic Syndrome - epidemiology; Middle Aged; Multivariate Analysis; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocardial Infarction - prevention & control; Odds Ratio; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Prospective Studies; Risk Assessment; Risk Factors; Stents; Time Factors; Treatment Outcome; Troponin I - blood; Turkey - epidemiology
• ISSN: 1897-5593; 1897-5593; 1898-018X
• DOI: 10.5603/CJ.a2014.0101

Metabolic syndrome (MetS) has been reported as a risk factor for cardiovascular events. The aim of the present study is to investigate the association between chronic angiotensin-converting enzyme inhibitors (ACE-I) therapy and the rate of periprocedural myocardial infarction (PMI) after elective coronary stenting among patients with MetS. The inclusion criteria were MetS and plan for elective percutaneous coronary intervention. To assess the effect of ACE-I treatment on the incidence of PMI, measurements of cardiac biomarkers (CK-MB mass and troponin I) were performed at baseline and 24 h after the procedure. A total of 459 patients fulfilling the inclusion criteria were recruited to chronic ACE-I treatment and ACE-I naive groups in a 2/1 ratio. Baseline troponin I and CK-MB levels were similar in both treatment groups, whereas they were significantly lower in ACE-I group 24 h after the procedure. Univariate analysis identified body mass index (BMI), LDL cholesterol, nitrate and ACE-I use as significant factors for the development of PMI. Multivariate regression model revealed that body mass index increased and use of nitrate and ACE-I decreased the probability of PMI independent from confounding factors (OR 1.14, 95% CI 1.05-1.23, p = 0.002 for BMI; OR 0.26, 95% CI 0.14-0.48, p = 0.01 for nitrate use, OR 0.51, 95% CI 0.27-0.93, p = 0.03 for ACE-I use). This prospective observational cohort trial demonstrated that chronic ACE-I therapy was an independent predictor for reduced PMI among patients with MetS who underwent elective coronary intervention.