Association of Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers on LVAD Support and Risk of Gastrointestinal Bleeding: A Multi-Center Analysis

Abstract

We have previously reported an association between angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) use and reduced rates of gastrointestinal bleeding (GIB) after the left ventricular assist device (LVAD) implantation. The purpose of this analysis was to test this association in a large, multi-center database inclusive of HeartMate 3 devices. Patients at two centers with a first time continuous flow (CF) LVAD implant with complete medication and gastrointestinal bleeding data were included in the analysis (total n=648). ACEI/ARB utilization was defined as ACEI or ARB use at discharge or within the first 3 months after LVAD implantation. GIB events were captured for the first two years on LVAD support. Negative binomial regression analyses were performed to determine the association between ACEI/ARB use and the number of GIB events on LVAD support. The mean age of the study cohort was 57 years (+/- 14), 45% were bridge to transplant (BTT), and 13% received HeartMate 3 devices. Use of either an ACEI or ARB was associated with a reduction in the incidence rate of GIB on LVAD support (unadjusted 51% reduction in incidence rate ratio (IRR), 95% CI 30-66% reduction, p<0.00001). Adjusted 54% reduction in IRR, 95% CI 32-69% reduction, p=0.0001). The final model was adjusted for age, sex, INTERMACS profile, BTT status, serum creatinine, albumin, body mass index, and index right atrial pressure. Patients who were prescribed an ACEI or ARB on LVAD support experienced reduced incidence rates of GIB in this large, multi-center contemporary CF LVAD dataset.