Effect of chronic angiotensin converting enzyme inhibitor therapy on myocardial injury in patients undergoing percutaneous coronary interventions.

BACKGROUND: Procedural MI is a frequent complication of percutaneous coronary intervention (PCI). Angiotensin converting enzyme inhibitors (ACE-I) have been shown to reduce ischemic events in the setting of acute myocardial infarction (MI) and heart failure. OBJECTIVE: We sought to evaluate whether chronic ACE-I treatment prior to PCI reduces the incidence of procedural MI. METHODS: The study cohort included consecutive patients from January 2003 to August 2004 undergoing PCI with normal baseline serum creatinine kinase (CK) and cardiac CK isoform (CK-MB) (n = 265). Procedural MI was defined as CK-MB elevation ≥ 3 times the upper limit of normal. RESULTS: Patients on chronic ACE-I had a higher baseline prevalence of adverse prognostic features including diabetes (p = 0.02) and a trend towards a lower incidence of drug-eluting stent use (p = 0.07). Using multiple logistic regression, patients on chronic ACE-I therapy (n = 138) had a 64% reduction in procedural MI compared with those not on ACE-I (n = 127; odds ratio = 0.36; 95% confidence intervals 0.13-0.99; p = 0.05). Long-term outcomes, including death and major adverse cardiac events (MACE) (combined total of death, MI and target lesion revascularization were similar in the two groups. Procedural MI was, however, associated with increased MACE during follow up (60% vs. 35.4%; p = 0.035). CONCLUSION: Chronic ACE-I therapy before PCI may reduce the incidence of procedural MI.