title: Effect of angiotensin-converting enzyme inhibitors and receptor blockers on appropriate implantable cardiac defibrillator shock in patients with severe systolic heart failure (from the GRADE Multicenter Study).
abstract: Sudden cardiac death (SCD) is a leading cause of mortality in patients with cardiomyopathy. Although angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) decrease cardiac mortality in these cohorts, their role in preventing SCD has not been well established. We sought to determine whether the use of ACEi or ARB in patients with cardiomyopathy is associated with a lower incidence of appropriate implantable cardiac defibrillator (ICD) shocks in the Genetic Risk Assessment of Defibrillator Events study that included subjects with an ejection fraction of ≤30% and ICDs. Treatment with ACEi/ARB versus no-ACEi/ARB was physician dependent. There were 1,509 patients (mean age [SD] 63 [12] years, 80% men, mean [SD] EF 21% [6%]) with 1,213 (80%) on ACEi/ARB and 296 (20%) not on ACEi/ARB. We identified 574 propensity-matched patients (287 in each group). After a mean (SD) of 2.5 (1.9) years, there were 334 (22%) appropriate shocks in the entire cohort. The use of ACEi/ARB was associated with lower incidence of shocks at 1, 3, and 5 years in the matched cohort (7.7%, 16.7%, and 18.5% vs 13.2%, 27.5%, and 32.0%; RR = 0.61 [0.43 to 0.86]; p = 0.005). Among patients with glomerular filtration rate (GFR) >60 and 30 to 60 ml/min/1.73 m(2), those on no-ACEi/ARB were at 45% and 77% increased risk of ICD shock compared with those on ACEi/ARB, respectively. ACEi/ARB were associated with significant lower incidence of appropriate ICD shock in patients with cardiomyopathy and GFR ≥30 ml/min/1.73 m(2) and with neutral effect in those with GFR <30 ml/min/1.73 m(2).
authors: Division of Cardiovascular Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Wael A
authors: WA
authors: AlJaroudi
authors: Division of Cardiovascular Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: mr48@aub.edu.lb.
authors: Marwan M
authors: MM
authors: Refaat
authors: Department of Internal Medicine, Outcomes Research Unit, Beirut, Lebanon; Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Robert H
authors: RH
authors: Habib
authors: Department of Internal Medicine, Outcomes Research Unit, Beirut, Lebanon; Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Laila
authors: L
authors: Al-Shaar
authors: Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Madhurmeet
authors: M
authors: Singh
authors: Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors: Rebecca
authors: R
authors: Gutmann
authors: Division of Cardiology, Emory University School of Medicine, Atlanta, GA.
authors: Heather L
authors: HL
authors: Bloom
authors: Division of Cardiology, The Warren Alpert Medical School of Brown University, Providence, RI.
authors: Samuel C
authors: SC
authors: Dudley
authors: Division of Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA.
authors: Patrick T
authors: PT
authors: Ellinor
authors: Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Samir F
authors: SF
authors: Saba
authors: Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA; Cardiology Division, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors: Alaa A
authors: AA
authors: Shalaby
authors: Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH.
authors: Raul
authors: R
authors: Weiss
authors: Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Dennis M
authors: DM
authors: McNamara
authors: Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Indrani
authors: I
authors: Halder
authors: Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors: Barry
authors: B
authors: London
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors