Use of angiotensin-converting enzyme inhibitors and cardiovascular outcomes following primary vascular surgery: a nationwide propensity score matched follow-up study

Vasc Endovascular Surg. 2012 Oct;46(7):515-23. doi: 10.1177/1538574412455229. Epub 2012 Jul 27.

Abstract

Objective: To examine the association between angiotensin-converting enzyme (ACE) inhibitor use and clinical outcome after primary vascular reconstruction in a population-based follow-up study.

Methods: All Danish patients undergoing primary vascular surgical reconstruction between 1996 and 2007 were included. For each ACE user up to 5 nonuser was identified using propensity score matching followed by Cox regression. All drugs were included as time-dependent variables.

Results: Totally 17 495 matched patients with a median follow-up period of 582 days were included. All-cause mortality was 20.4% for ACE users and 24.9% for nonusers (adjusted hazard ratio [adj HR] 0.88, 95% confidence interval [CI] 0.81-0.96). The cumulative risk of myocardial infarction was 6.2% for ACE users and 4.7% for nonusers (adj HR 1.20, 95%CI 1.03-1.39). Cumulative risk of new vascular surgery was 24.0% for ACE users and 23.1% for nonusers (adj HR 1.21, 95% CI 1.13-1.30). No differences were seen concerning stroke and major amputation.

Conclusion: The ACE use was associated with lower all-cause mortality but also an increased long-term risk of recurrent vascular reconstruction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / drug therapy*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / surgery
  • Denmark
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / etiology
  • Peripheral Arterial Disease / mortality
  • Peripheral Arterial Disease / surgery*
  • Propensity Score
  • Proportional Hazards Models
  • Registries
  • Reoperation
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures / adverse effects*
  • Vascular Surgical Procedures / mortality

Substances

  • Angiotensin-Converting Enzyme Inhibitors