title: Association between angiotensin-converting enzyme inhibitors and troponin in acute coronary syndrome.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of mortality in the western world and its treatment should be optimized to decrease severe adverse events.
  
  
  OBJECTIVE
  To determine the effect of previous use of angiotensin-converting enzyme inhibitors on cardiac troponin I measurement in patients with acute coronary syndrome without ST-segment elevation and evaluate clinical outcomes at 180 days.
  
  
  METHODS
  Prospective, observational study, carried out in a tertiary center, in patients with acute coronary syndrome without ST-segment elevation. Clinical, electrocardiographic and laboratory variables were analyzed, with emphasis on previous use of angiotensin-converting enzyme inhibitors and cardiac troponin I. The Pearson chi-square tests (Pereira) or Fisher's exact test (Armitage) were used, as well as the non-parametric Mann-Whitney's test. Variables with significance levels of <10% were submitted to multiple logistic regression model.
  
  
  RESULTS
  A total of 457 patients with a mean age of 62.1 years, of whom 63.7% were males, were included. Risk factors such as hypertension (85.3%) and dyslipidemia (75.9%) were the most prevalent, with 35% of diabetics. In the evaluation of events at 180 days, there were 28 deaths (6.2%). The statistical analysis showed that the variables that interfered with troponin elevation (> 0.5 ng / mL) were high blood glucose at admission (p = 0.0034) and ST-segment depression ≥ 0.5 mm in one or more leads (p = 0.0016). The use of angiotensin-converting inhibitors prior to hospitalization was associated with troponin ≤ 0.5 ng / mL (p = 0.0482). The C-statistics for this model was 0.77.
  
  
  CONCLUSIONS
  This study showed a correlation between prior use of angiotensin-converting enzyme inhibitors and reduction in the myocardial necrosis marker troponin I in patients admitted for acute coronary syndrome without ST-segment elevation. However, there are no data available yet to state that this reduction could lead to fewer severe clinical events such as death and re-infarction at 180 days.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Luiz
authors.initials: L
authors.lastname: Minuzzo
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Elizabete Silva dos
authors.initials: ES
authors.lastname: Santos
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Ari
authors.initials: A
authors.lastname: Timerman
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000378:metabolism; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006321:Heart / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000032:analysis*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D019210:Troponin I