title: Use of renin-angiotensin system blockers in acute coronary syndromes: findings from Get With the Guidelines-Coronary Artery Disease Program.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) initiated after myocardial infarction (MI) reduce mortality and are American College of Cardiology/American Heart Association guideline recommended. Yet the extent to which ACEI/ARB therapy is applied in patients with acute coronary syndrome at hospital discharge is unclear.
  
  
  RESULTS
  We performed an observational analysis of 80 241 patients admitted with an acute coronary syndrome and discharged home from 311 U.S. hospitals participating in the Get With the Guidelines-Coronary Artery Disease Program from January 2005 to December 2009. Among the 60,847 patients with an American College of Cardiology/American Heart Association class I indication (left ventricular dysfunction or medical history of heart failure, hypertension, diabetes mellitus, or chronic kidney disease), 49,682 (81.7%) received ACEI/ARB with an increase in the rate of treatment over the study period (76.7%-84.6%; adjusted odds ratio, 1.17; 95% confidence interval, 1.10-1.24; P<0.001, per calendar year). In-hospital coronary artery bypass grafting and renal insufficiency were independently associated with lower use (adjusted odds ratio, 0.55; 95% confidence interval, 0.48-0.63 and adjusted odds ratio, 0.58; 95% confidence interval, 0.52-0.64, respectively).
  
  
  CONCLUSIONS
  Results from this large U.S. national registry suggest that 1 in 5 eligible patients hospitalized for acute coronary syndrome failed to receive American College of Cardiology/American Heart Association class I guideline-recommended ACEI/ARB therapy, and the use varies by patient factors. In particular, the low likelihood of ACEI/ARB after coronary artery bypass grafting surgery or in patients with renal insufficiency raises concern. These findings highlight an unmet need in this population and provide an incentive for additional quality improvement efforts.
authors.affiliation: Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Bainey
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D000368:Aged; D000572:American Heart Association; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D014481:United States
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: acute coronary syndrome; angiotensin receptor blockers; angiotensin-converting enzyme inhibitors