Long-term impact of renin-angiotensin system inhibitors for secondary prevention in patients with chronic kidney disease who underwent percutaneous coronary intervention

The impact of renin-angiotensin system (RAS) inhibitors for secondary prevention in patients with coronary artery disease and coexisting chronic kidney disease (CKD) in the long-term remains unclear. Therefore, we investigated how RAS inhibitor use affects long-term clinical outcomes in patients with CKD who underwent percutaneous coronary intervention (PCI). A total of 1190 patients with CKD who underwent their first PCI between 2000 and 2018 were included in this study, and were divided into two groups based on the presence or absence of RAS inhibitor use. In total, 293 patients (24.6%) developed 3-point major adverse cardiovascular events (3P-MACE), including cardiovascular death, non-fatal acute coronary syndrome and non-fatal stroke, and 136 patients (11.4%) developed heart failure (HF). The cumulative incidence rate of 3P-MACE in the RAS inhibitor group was significantly lower than in the non-RAS inhibitor group (31.7% vs. 40.2%, log-rank test, p  = 0.034). However, the cumulative incidence rate of admission for HF in the RAS inhibitor group was significantly higher than in the non-RAS inhibitor group (28.2% vs. 13.8%, log-rank test, p  < 0.001). In conclusion, the long-term RAS inhibitor use in patients with CKD after PCI could contribute to prevention of cardiovascular events but may increase the risk of HF.