Angiotensin-Converting Enzyme Inhibitor Prescription for Patients With Single Ventricle Physiology Enrolled in the NPC-QIC Registry.
Angiotensin-Converting Enzyme Inhibitor Prescription for Patients With Single Ventricle Physiology Enrolled in the NPC-QIC Registry.
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DOI：
10.1161/jaha.119.014823
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发表时间：
2020-05-18
影响因子：
5.4
通讯作者：
Anderson JB
中科院分区：
文献类型：
--
作者：
Hansen JE;Brown DW;Hanke SP;Bates KE;Tweddell JS;Hill G;Anderson JB
在缓解左心发育不全综合征期间常规使用血管紧张素转换酶抑制剂（ACEI）存在争议。我们试图使用 NPC-QIC（国家儿科心脏病质量改进协作组织）登记处描述 1 期姑息治疗（I 期诺伍德手术）出院和 2 期姑息治疗（II 期上腔静脉肺吻合术）入院之间的 ACEI 处方。对 2008 年至 2016 年参加 NPC-QIC 的所有患者 (n=2180) 进行分析，包括术前解剖、危险因素和超声心动图数据。 38% 的患者在诺伍德手术 I 期出院时服用 ACEI。与 2010 年前相比，2011 年至 2016 年 ACEI 处方有所下降（36.8% 对比 45%；P=0.005），各中心差异显着（范围 7-100%；P<0.001），且处方率下降与中心容量增加相关（P=0.004）。各组之间的分期死亡率（P=0.662）、房室瓣反流变化（P=0.101）或心室功能障碍变化（P=0.134）没有差异。在所有患者的多变量分析中，房室间隔缺损（比值比 [OR]，1.84；95% CI，1.28-2.65）或右心室双出口（OR，1.47；CI，1.02-2.11）和术前机械通气（OR，1.37；95% CI，1.12-1.68）与 ACEI 处方增加相关。在对具有完整超声心动图数据的患者 (n=812) 进行多变量分析时，ACEI 处方在至少中度房室瓣关闭不全的患者中更为常见（OR，1.88；95% CI，1.22-2.31）。尽管其益处的证据有限，但 ACEI 处方在中期仍然很常见。 ACEI 处方与术前机械通气、右心室双出口和房室瓣关闭不全相关，且中心间差异显着。 ACEI 处方与死亡率、心室功能障碍或间期房室瓣反流的降低无关。
The routine use of angiotensin‐converting enzyme inhibitors (ACEI) during palliation of hypoplastic left heart syndrome is controversial. We sought to describe ACEI prescription in the interstage between stage 1 palliation (stage I Norwood procedure) discharge and stage 2 palliation (stage II superior cavopulmonary anastomosis procedure) admission using the NPC‐QIC (National Pediatric Cardiology Quality Improvement Collaborative) registry. Analysis of all patients (n=2180) enrolled in NPC‐QIC from 2008 to 2016 included preoperative anatomy, risk factors, and echocardiographic data. ACEI were prescribed at stage I Norwood procedure discharge in 38% of patients. ACEI prescription declined from 2011 to 2016 compared with pre‐2010 (36.8% versus 45%; P=0.005) with significant variation across centers (range 7–100%; P<0.001) and decreased prescribing rates associated with increased center volume (P=0.004). There was no difference in interstage mortality (P=0.662), change in atrioventricular valve regurgitation (P=0.101), or change in ventricular dysfunction (P=0.134) between groups. In multivariable analysis of all patients, atrioventricular septal defect (odds ratio [OR], 1.84; 95% CI, 1.28–2.65) or double outlet right ventricle (OR, 1.47; CI, 1.02–2.11), and preoperative mechanical ventilation (OR, 1.37; 95% CI, 1.12–1.68) were associated with increased ACEI prescription. In multivariable analysis of patients with complete echocardiographic data (n=812), ACEI prescription was more common with at least moderate atrioventricular valve regurgitation (OR, 1.88; 95% CI, 1.22–2.31). ACEI prescription remains common in the interstage despite limited evidence of benefit. ACEI prescription is associated with preoperative mechanical ventilation, double outlet right ventricle, and atrioventricular valve regurgitation with marked inter‐center variation. ACEI prescription is not associated with reduction in mortality, ventricular dysfunction, or atrioventricular valve regurgitation during the interstage.