Plasma renin activity has a complex prognostic role in patients with acute coronary syndromes

Background: Plasma renin activity (PRA) has been related to all-cause mortality and cardiovascular events in patients with cardiovascular disease. However, data from patients with acute coronary syndromes (ACS) are sparse. Methods: Determination of PRA was made in 550 patients with ACS, including a subgroup of 287 patients not on treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers or diuretics, and without heart failure. We evaluated the relations between PRA and all-cause mortality after three years and long-term, and to cardiovascular events after median 8.7 years. Adjustments were made for variables that influenced the hazard ratio (HR) > 5% for the relation between PRA and outcome. Results: Baseline PRA was associated with all-cause mortality during three-years (unadjusted HR 1.74 per 1 SD increase in logarithmically transformed PRA; 95% confidence interval (CI) 1.39-2.16, p < 0.0001) and long-term (HR 1.12, CI 1.00-1.25,p = 0.046). After adjustments, only the three-year assodat ion remained significant. In unadjusted analyses, PRA was associated with cardiovascular death, but not with nonfatal cardiovascular events. In the subgroup there was an inverse relation between PRA and long-term all-cause mortality. Conclusion: Higher PRA was a significant independent predictor of all-cause mortality after three years, but not at long-term follow-up and not significantly associated with cardiovascular incidence. The renin-angiotensin-system pa tho physiology is ofgreat interest, not least due to its assodation with the COVID-19 pandemic. Our findings indicate a need for further research on the prognostic/predictive aspects of the renin-angiotensin-system in ACS. (C) 2020 The Author(s). Published by Elsevier B.V.

Automated summary

The study found that PRA is associated with all-cause mortality in patients with acute coronary syndromes, with higher PRA serving as an independent predictor of all-cause mortality after three years. However, PRA is not significantly associated with long-term cardiovascular events, indicating the need for further research on the prognostic/predictive role of the renin-angiotensin system in ACS.