(135) Characteristics and 1-Year Mortality Outcome of ACS Patients Receiving ACEIs/ARBs: A 10-Year Retrospective Analysis of The Malaysian National Cardiovascular Database Registry

Publication Number: 809

Background: Despite having been shown to improve the survival of ACS patients, the usage of ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as part of evidence-based secondary preventative cardiovascular pharmacotherapies remained underutilized in some countries.

Objectives: This study examined the trends, characteristics, and outcomes of ACS patients prescribed with ACEIs/ARBs in a multi-ethnic, middle-income country in Southeast Asia.

Methods: This retrospective study utilized the Malaysian National Cardiovascular Disease- ACS registry. Consecutive ACS patient’s data of those ≥ 20 years old admitted from 2008 to 2017 were identified (n=81,506). Demographics, clinical characteristics and 1-year all-cause mortality outcome of ACS patients prescribed with ACEIs/ARBs on-discharge over the 10-years were examined. Comparisons across groups of interests were performed using the Chi-square test. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR) of receiving ACEIs/ARBs. Cox proportional-hazard regression model was used to examine the survival time of patients with ACEIs/ARBs compared to those without, adjusted for clinical characteristics, percutaneous coronary intervention and other evidence-based pharmacotherapies.

Results: ACS patients admitted had a mean age of 59 (±12) years (78% male, 52% Malay ethnicity, 45% STEMI). On-discharge ACEIs/ARBs prescription showed increasing patterns in the 10 years (61% 2008, 63% 2017); but remained below 70%. Its prescription were significantly higher in < 65 years old patients (69%), smokers (71%), overweight/obese (80%) and concurrent hypertension (72%) (p < 0.001). ACEIs/ARBs were more likely to be given to those with hypertension (OR= 1.691, 95% CI=1.587-1.802), overweight/obese (OR=1.143, 95% CI= 1.067-1.224) and smokers (OR=1.143, 95% CI= 1.070-1.221), while less likely to those who presented with cardiogenic shock (OR=0.466, 95% CI=0.411-0.528), concurrent diabetes mellitus (DM) (OR=0.888, 95% CI=0.836-0.943) or chronic kidney disease (CKD) (OR=0.354, 95% CI=0.317-0.395) (p < 0.001). Those who received ACEIs/ARBs had better 1-year survival rate (adjusted HR= 0.620, 95 % CI= 0.568-0.677, p< 0.001).

Conclusions: On-discharged ACEIs/ARBs prescription in Malaysian ACS patients has shown an increasing trend and better 1-year survival rate. Clinical factors such as DM and CKD influenced ACEIs/ARBs prescription. Physician preference in these conditions should be explored to improve prescribing of ACEIs/ARBs as secondary preventative therapies in post-ACS patients.