Impact of Angiotensin-Converting Enzyme Inhibitors Administration Prior To Acute Ischemic Stroke Onset on In-Hospital Mortality

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Journal Title, Volume, Page: 
The Journal of Cardiovascular Pharmacology and Therapeutics. 2010 Sep;15(3):274-81
Year of Publication: 
2010
Authors: 
Yahaya Hassan
Clinical Pharmacy Program, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
Noorizan Abd Aziz
Clinical Pharmacy Program, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
Samah W. Al-Jabi
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Irene Looi
Clinical Research Centre, Hospital Pulau Pinang, Penang, Malaysia
Sa'ed H. Zyoud
Poison Control And Drug Information Center (PCDIC), An-Najah National University, P.O. Box 7, Nablus, Palestine
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Introduction: Angiotensin-converting enzyme inhibitors (ACEIs) have shown promising results in decreasing the incidence and the severity of ischemic stroke in populations at risk and in improving ischemic stroke outcomes. Objectives: The objectives of this study were to investigate the impact of ACEI use before ischemic stroke onset on in-hospital mortality and to identify the independent predictors of in-hospital mortality among patients with ischemic stroke.
Methods and Materials: A retrospective cohort study of all patients with acute ischemic stroke attending the hospital from June 1, 2008 to November 30, 2008 was performed. Data were collected from medical records and included demographic information, diagnostic information, risk factors, previous ACEI use, and vital discharge status. Statistical Package for Social Sciences (SPSS) version 15 was used for data analysis.
Results: A total of 327 patients with acute ischemic stroke were studied, of which 119 (36.4%) had documented previous ACEI use. During the study period, 52 (15.9%) of the patients with acute ischemic stroke died in hospital. In-hospital mortality was significantly lower among patients who were on ACEI before the attack (P = 0.002). The independent predictors for in-hospital mortality among patients with ischemic stroke were age ≥65 years (P < .001), the presence of diabetes mellitus (P = .012), renal impairment (P = .002), and heart failure (P = .001). Moreover, prior use of ACEI was an independent predictor for survival after ischemic stroke attack (P < .001).
Conclusion: This study provides evidence that the prophylactic administration of ACEI before ischemic stroke may be a potential life-saving strategy. Furthermore, knowledge of in-hospital mortality predictors is necessary to improve survival rate after acute stroke.

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