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; sartans ) decrease cardiac mortality in these cohorts, their role in preventing sudden cardiac death has not been well established.
Researchers sought to determine whether the use of ACEi or sartans 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 less than or equal to 30% and ICDs.
Treatment with ACEi / sartan versus no-ACEi / sartan was physician dependent.
There were 1,509 patients ( mean age 63 years, 80% men, mean EF 21% ) with 1,213 ( 80% ) on ACEi / sartan and 296 ( 20% ) not on ACEi/ARB.
Researchers have identified 574 propensity-matched patients ( 287 in each group ).
After a mean of 2.5 years, there were 334 ( 22% ) appropriate shocks in the entire cohort.
The use of ACEi / sartan 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 ) more than 60 and 30 to 60 ml/min/1.73 m2, those on no-ACEi / sartan were at 45% and 77% increased risk of ICD shock compared with those on ACEi / sartan, respectively.
ACEi / sartans were associated with significant lower incidence of appropriate ICD shock in patients with cardiomyopathy and GFR greater than or equal to 30 ml/min/1.73 m2 and with neutral effect in those with GFR less than 30 ml/min/1.73 m2. ( Xagena )
AlJaroudi WA et al, Am J Cardiol 2015; 115: 924–931