title: Use of angiotensin-converting enzyme inhibitors and cardiovascular outcomes following primary vascular surgery: a nationwide propensity score matched follow-up study.
abstract: OBJECTIVE
  To examine the association between angiotensin-converting enzyme (ACE) inhibitor use and clinical outcome after primary vascular reconstruction in a population-based follow-up study.
  
  
  METHODS
  All Danish patients undergoing primary vascular surgical reconstruction between 1996 and 2007 were included. For each ACE user up to 5 nonuser was identified using propensity score matching followed by Cox regression. All drugs were included as time-dependent variables.
  
  
  RESULTS
  Totally 17 495 matched patients with a median follow-up period of 582 days were included. All-cause mortality was 20.4% for ACE users and 24.9% for nonusers (adjusted hazard ratio [adj HR] 0.88, 95% confidence interval [CI] 0.81-0.96). The cumulative risk of myocardial infarction was 6.2% for ACE users and 4.7% for nonusers (adj HR 1.20, 95%CI 1.03-1.39). Cumulative risk of new vascular surgery was 24.0% for ACE users and 23.1% for nonusers (adj HR 1.21, 95% CI 1.13-1.30). No differences were seen concerning stroke and major amputation.
  
  
  CONCLUSIONS
  The ACE use was associated with lower all-cause mortality but also an increased long-term risk of recurrent vascular reconstruction.
authors: Department of Vascular Surgery, Regionshospitalet, Viborg, Denmark. annette.hoegh@viborg.rm.dk
authors: Annette
authors: A
authors: Høgh
authors: Jes S
authors: JS
authors: Lindholt
authors: Henrik
authors: H
authors: Nielsen
authors: Leif P
authors: LP
authors: Jensen
authors: Søren P
authors: SP
authors: Johnsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000601:surgery*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors