Abstract 3462: The Cardioprotective Effects Of The Angiotensin-converting Enzyme Inhibitor Perindopril In Patients With Stable Coronary Artery Disease Are Not Modified By Mild to Moderate Renal Insufficiency: Results From The Europa-trial.

Abstract

The cardioprotective effects of the ACE-inhibitor perindopril in patients with stable coronary artery disease are not modified by renal function: Results from the EUROPA-trial. Objective: To examine whether the cardioprotective effects of perindopril are modified by renal function in patients with stable coronary artery disease. Background: A recent study reported that an impaired renal function identified a subgroup of patients with stable coronary artery disease more likely to benefit of ACE-inhibition therapy. In light of the growing interest in tailored-therapy for targeting medications to specific subgroups, remarks on the consistency of the treatment effect by ACE-inhibitors are highly important. Methods: The present study involved 12056 patients with stable coronary artery disease without heart failure randomized to perindopril or placebo. Estimated GFR (eGFR) was calculated using the abbreviated MDRD-equation. Results: Mean eGFR was 76.2 (18.1) ml/min per 1.73 m 2 . During follow-up, the primary endpoint (cardiovascular death, non-fatal myocardial infarction, or resuscitated cardiac arrest) occurred in 454/5761 patients (7.9%) with eGFR ≥ 75 and in 631/6295 patients (10.0%) with eGFR<75. Treatment benefits of perindopril were apparent in both patient groups either with eGFR≥ 75 (HR 0.77; 95%CI 0.64 – 0.93) or eGFR≥ 75 (HR 0.84; 95%CI 0.72– 0.98). We observed no significant interaction between renal function and treatment benefit (Pv=0.47). Using different cut-off points of eGFR at the level of 60 or 90 resulted in similar trends. Conclusion: The treatment benefit of perindopril is consistent and not modified by the level of renal function.