Renin–angiotensin system inhibition and in-hospital mortality in acute coronary syndrome patients with advanced renal dysfunction: findings from CCC-ACS project and a nationwide electronic health record-based cohort in China
Authors' conclusion
Based on two nationwide cohorts in China in contemporary practice, we demonstrated that ACEI/ARB therapy initiated within 24 h of admission is associated with a reduction in in-hospital mortality in ACS patients with advanced renal dysfunction.
Study context
- Population
- Acute coronary syndrome (ACS) patients with advanced renal dysfunction (admission estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m²), Chinese National Electronic Disease Surveillance System Platform (CNEDSSP) (2014–2018) and CCC-ACS (2014–2019) cohorts, China3,288 CNEDSSP + 3916 CCC-ACS
- Exposure
- Early ACEi/ARB vs no early ACEi/ARB
- ACEI/ARBn = 2,647
- Outcome
- In-hospital mortality
- Follow-up
- In-hospital
Methodological detailstwo nationwide cohorts, propensity-score matched (1:1), random effect meta-analysis of the two cohorts
- Two nationwide cohorts
- Propensity-score matched (1:1)
- Random effect meta-analysis of the two cohorts
Main finding
As reported in the abstract
ACEI/ARB vs No ACEI/ARBEstimate (95% CI)
CNEDSSP cohort
HR 0.61(0.45–0.82)
CCC-ACS cohort
HR 0.66(0.46–0.95)
Random effect meta-analysis of both cohorts
risk ratio 0.68(0.55–0.84)
Observational data: associations, not effects.
Original publication
Renin–angiotensin system inhibition and in-hospital mortality in acute coronary syndrome patients with advanced renal dysfunction: findings from CCC-ACS project and a nationwide electronic health record-based cohort in China. Eur Heart J Qual Care Clin Outcomes. Published 2 February 2023. doi:10.
Summarised from the published abstract; every number is checked against it