S. Kennon et al., Angiotensin-converting enzyme inhibition is associated with reduced troponin release in non-ST-elevation acute coronary syndromes, J AM COL C, 38(3), 2001, pp. 724-728
Citations number
30
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES This study was done to determine the effects of angiotensin-conv
erting enzyme (ACE) inhibition and other clinical factors on troponin relea
se in non-ST-elevation acute coronary syndrome (ACS).
BACKGROUND Troponin is now widely used as a marker of risk in ACS, but dete
rminants of its release have not been defined.
METHODS This was a prospective cohort study of 301 consecutive patients adm
itted with non-ST-elevation ACS. Baseline clinical data were recorded, ACE
gene polymorphism was determined and serial blood samples were obtained for
troponin-I assay.
RESULTS Significant troponin-I release (>0.1 mug/l) was detected in 93 (31%
) patients. Pretreatment with ACE inhibitors, recorded in 53 patients (17.6
%), independently reduced the odds of troponin-I release (odds ratio 0.25;
95% confidence intervals 0.10 to 0.64) and was associated with lower maximu
m troponin-I concentrations (median [interquartile range]) compared with pa
tients not pretreated with ACE inhibitors (0.44 mug/l [0.19 to 2.65 mug/l]
vs. 4.18 mug/l [0.91 to 12.41 mug/l], p = 0.01). Pretreatment with aspirin,
recorded in 173 patients (57.5%), did not significantly reduce the odds of
troponin-I release after adjustment but was associated with lower maximum
troponin-I concentrations compared with patients not pretreated with aspiri
n (2.31 mug/l [0.72 to 8.02 mug/l] vs. 5.85 mug/l [1.19 to 12.79 mug/l], p
= 0.05). The ACE genotyping (n = 268) showed 81 patients (30%) DD homozygou
s and 77 (29%) II homozygous. There was no association between ACE genotype
and troponin release.
CONCLUSIONS We conclude that ACE inhibition reduces troponin release in non
-ST-elevation ACS. This is likely to be mediated by the beneficial effects
of treatment on vascular reactivity and the coagulation system, (C) 2001 by
the American College of Cardiology.