Renin-angiotensin-system modulators and the incidence of atrial fibrillation following hospitalization for coronary artery disease.

Abstract

AIMS:

Previous studies have suggested that upstream medical therapy to modulate the renin-angiotensin axis may facilitate left atrial remodelling and thereby prevent new-onset atrial fibrillation (AF). The purpose of this study was to evaluate the association between angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blockers (ARB) on new-onset AF in a large cohort of patients with coronary artery disease (CAD).

METHODS AND RESULTS:

This was a population-based study of 28 620 patients, from community-dwelling Medicare beneficiaries who had been hospitalized for acute myocardial infarction or coronary revascularization (1995-2004). All patients, 65 years and older, had a mean follow-up period of upto 3.8 ± 3.0 years. Patients with a history of AF before and during hospitalization were excluded. We compared the incidence of new-onset AF between patients who were (N= 10 918) and were not (N= 17 702) prescribed ACEI and/or ARB within 1 month of hospital discharge following cardiac event. New-onset AF within 5 and 10 years was 39.1 and 61.1%, respectively, in patients who received ACEI/ARB, compared 34.9 and 53.6% in patients who did not receive them [unadjusted hazard ratio (HR): 1.16; 95% confidence interval (CI): 1.11, 1.21]. Multivariable analysis adjusting for patient- and hospital-related characteristics indicated that ACEI/ARB use independently had no impact on the risk of developing new-onset AF compared with non-users (adjusted HR: 0.99; 95% CI: 0.94, 1.04). Adjustment for propensity-score and health-seeking behaviours yielded nearly identical results.

CONCLUSION:

Angiotensin converting enzyme inhibitor/ARB therapy initiated within 1 month after hospital discharge is not associated with a reduction in the risk of new-onset AF after myocardial infarction or coronary revascularization.

• Authors: Jagmeet P Singh, Alexander Kulik, Raisa Levin, Patrick T Ellinor, Jeremy Ruskin, Jerry Avorn, Niteesh K Choudhry
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 14 Issue 9 Pg. 1287-93 (Sep 2012) ISSN: 1532-2092 [Electronic] England
• PMID: 22539600 (Publication Type: Journal Article)

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors

Topics

• Aged
• Aged, 80 and over
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Atrial Fibrillation (drug therapy, epidemiology, prevention & control)
• Cohort Studies
• Coronary Artery Disease (drug therapy, epidemiology)
• Female
• Hospitalization (statistics & numerical data)
• Humans
• Incidence
• Male
• Myocardial Infarction (drug therapy, epidemiology)
• Renin-Angiotensin System (drug effects)
• Risk
• Treatment Outcome