Ramipril in High-Risk Patients With COVID-19.
Identifieur interne : 000209 ( Main/Corpus ); précédent : 000208; suivant : 000210Ramipril in High-Risk Patients With COVID-19.
Auteurs : Ignacio J. Amat-Santos ; Sandra Santos-Martinez ; Diego L Pez-Otero ; Luis Nombela-Franco ; Enrique Gutiérrez-Ibanes ; Raquel Del Valle ; Erika Mu Oz-García ; Víctor A. Jiménez-Diaz ; Ander Regueiro ; Rocío González-Ferreiro ; Tomás Benito ; Xoan Carlos Sanmartin-Pena ; Pablo Catalá ; Tania Rodríguez-Gabella ; Jose Raúl Delgado-Arana ; Manuel Carrasco-Moraleja ; Borja Iba Ez ; J Alberto San RománSource :
- Journal of the American College of Cardiology [ 1558-3597 ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Aged, 80 and over (MeSH), Angiotensin-Converting Enzyme Inhibitors (adverse effects), Betacoronavirus (MeSH), Coronavirus Infections (chemically induced), Coronavirus Infections (mortality), Female (MeSH), Humans (MeSH), Male (MeSH), Pandemics (MeSH), Pneumonia, Viral (chemically induced), Pneumonia, Viral (mortality), Ramipril (adverse effects), Randomized Controlled Trials as Topic (MeSH), Risk Factors (MeSH), Spain (epidemiology).
- MESH :
- chemical , adverse effects : Angiotensin-Converting Enzyme Inhibitors, Ramipril.
- geographic , epidemiology : Spain.
- chemically induced : Coronavirus Infections, Pneumonia, Viral.
- mortality : Coronavirus Infections, Pneumonia, Viral.
- Aged, Aged, 80 and over, Betacoronavirus, Female, Humans, Male, Pandemics, Randomized Controlled Trials as Topic, Risk Factors.
Abstract
BACKGROUND
Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory-syndrome coronavirus-2 that interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting enzyme 2. This interaction has been proposed as a potential risk factor in patients treated with RAAS inhibitors.
OBJECTIVES
This study analyzed whether RAAS inhibitors modify the risk for COVID-19.
METHODS
The RASTAVI (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation) trial is an ongoing randomized clinical trial randomly allocating subjects to ramipril or control groups after successful transcatheter aortic valve replacement at 14 centers in Spain. A non-pre-specified interim analysis was performed to evaluate ramipril's impact on COVID-19 risk in this vulnerable population.
RESULTS
As of April 1, 2020, 102 patients (50 in the ramipril group and 52 in the control group) were included in the trial. Mean age was 82.3 ± 6.1 years, 56.9% of the participants were male. Median time of ramipril treatment was 6 months (interquartile range: 2.9 to 11.4 months). Eleven patients (10.8%) have been diagnosed with COVID-19 (6 in control group and 5 receiving ramipril; hazard ratio: 1.150; 95% confidence interval: 0.351 to 3.768). The risk of COVID-19 was increased in older patients (p = 0.019) and those with atrial fibrillation (p = 0.066), lower hematocrit (p = 0.084), and more comorbidities according to Society of Thoracic Surgeons score (p = 0.065). Admission and oxygen supply was required in 4.9% of patients (2 in the ramipril group and 3 in the control group), and 4 of them died (2 in each randomized group). A higher body mass index was the only factor increasing the mortality rate (p = 0.039).
CONCLUSIONS
In a high-risk population of older patients with cardiovascular disease, randomization to ramipril had no impact on the incidence or severity of COVID-19. This analysis supports the maintenance of RAAS inhibitor treatment during the COVID-19 crisis. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185).
DOI: 10.1016/j.jacc.2020.05.040
PubMed: 32470515
PubMed Central: PMC7250557
Links to Exploration step
pubmed:32470515Le document en format XML
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Electronic address: ijamat@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Santos Martinez, Sandra" sort="Santos Martinez, Sandra" uniqKey="Santos Martinez S" first="Sandra" last="Santos-Martinez">Sandra Santos-Martinez</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="L Pez Otero, Diego" sort="L Pez Otero, Diego" uniqKey="L Pez Otero D" first="Diego" last="L Pez-Otero">Diego L Pez-Otero</name><affiliation><nlm:affiliation>CIBERCV, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Nombela Franco, Luis" sort="Nombela Franco, Luis" uniqKey="Nombela Franco L" first="Luis" last="Nombela-Franco">Luis Nombela-Franco</name><affiliation><nlm:affiliation>Cardiovascular Institute, Hospital Clínico San Carlos, El Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Gutierrez Ibanes, Enrique" sort="Gutierrez Ibanes, Enrique" uniqKey="Gutierrez Ibanes E" first="Enrique" last="Gutiérrez-Ibanes">Enrique Gutiérrez-Ibanes</name><affiliation><nlm:affiliation>CIBERCV, Hospital General Gregorio Marañón and Universidad Carlos III, Madrid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Del Valle, Raquel" sort="Del Valle, Raquel" uniqKey="Del Valle R" first="Raquel" last="Del Valle">Raquel Del Valle</name><affiliation><nlm:affiliation>Hospital Universitario Central de Asturias, Oviedo, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Mu Oz Garcia, Erika" sort="Mu Oz Garcia, Erika" uniqKey="Mu Oz Garcia E" first="Erika" last="Mu Oz-García">Erika Mu Oz-García</name><affiliation><nlm:affiliation>CIBERCV, Hospital Virgen de la Victoria, Málaga, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Jimenez Diaz, Victor A" sort="Jimenez Diaz, Victor A" uniqKey="Jimenez Diaz V" first="Víctor A" last="Jiménez-Diaz">Víctor A. Jiménez-Diaz</name><affiliation><nlm:affiliation>Hospital Universitario de Vigo, Vigo, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Regueiro, Ander" sort="Regueiro, Ander" uniqKey="Regueiro A" first="Ander" last="Regueiro">Ander Regueiro</name><affiliation><nlm:affiliation>Hospital Clinic Univeristari, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Gonzalez Ferreiro, Rocio" sort="Gonzalez Ferreiro, Rocio" uniqKey="Gonzalez Ferreiro R" first="Rocío" last="González-Ferreiro">Rocío González-Ferreiro</name><affiliation><nlm:affiliation>Hospital Clínico Universitario, Salamanca, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Benito, Tomas" sort="Benito, Tomas" uniqKey="Benito T" first="Tomás" last="Benito">Tomás Benito</name><affiliation><nlm:affiliation>Hospital Universitario de León, León, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Sanmartin Pena, Xoan Carlos" sort="Sanmartin Pena, Xoan Carlos" uniqKey="Sanmartin Pena X" first="Xoan Carlos" last="Sanmartin-Pena">Xoan Carlos Sanmartin-Pena</name><affiliation><nlm:affiliation>CIBERCV, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Catala, Pablo" sort="Catala, Pablo" uniqKey="Catala P" first="Pablo" last="Catalá">Pablo Catalá</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Rodriguez Gabella, Tania" sort="Rodriguez Gabella, Tania" uniqKey="Rodriguez Gabella T" first="Tania" last="Rodríguez-Gabella">Tania Rodríguez-Gabella</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Delgado Arana, Jose Raul" sort="Delgado Arana, Jose Raul" uniqKey="Delgado Arana J" first="Jose Raúl" last="Delgado-Arana">Jose Raúl Delgado-Arana</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Carrasco Moraleja, Manuel" sort="Carrasco Moraleja, Manuel" uniqKey="Carrasco Moraleja M" first="Manuel" last="Carrasco-Moraleja">Manuel Carrasco-Moraleja</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Iba Ez, Borja" sort="Iba Ez, Borja" uniqKey="Iba Ez B" first="Borja" last="Iba Ez">Borja Iba Ez</name><affiliation><nlm:affiliation>CIBERCV, Centro Nacional de Investigaciones Cardiovasculares, IIS-Hospital Fundación Jimenez Diaz, Madrid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="San Roman, J Alberto" sort="San Roman, J Alberto" uniqKey="San Roman J" first="J Alberto" last="San Román">J Alberto San Román</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32470515</idno><idno type="pmid">32470515</idno><idno type="doi">10.1016/j.jacc.2020.05.040</idno><idno type="pmc">PMC7250557</idno><idno type="wicri:Area/Main/Corpus">000209</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000209</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Ramipril in High-Risk Patients With COVID-19.</title><author><name sortKey="Amat Santos, Ignacio J" sort="Amat Santos, Ignacio J" uniqKey="Amat Santos I" first="Ignacio J" last="Amat-Santos">Ignacio J. Amat-Santos</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain. Electronic address: ijamat@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Santos Martinez, Sandra" sort="Santos Martinez, Sandra" uniqKey="Santos Martinez S" first="Sandra" last="Santos-Martinez">Sandra Santos-Martinez</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="L Pez Otero, Diego" sort="L Pez Otero, Diego" uniqKey="L Pez Otero D" first="Diego" last="L Pez-Otero">Diego L Pez-Otero</name><affiliation><nlm:affiliation>CIBERCV, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Nombela Franco, Luis" sort="Nombela Franco, Luis" uniqKey="Nombela Franco L" first="Luis" last="Nombela-Franco">Luis Nombela-Franco</name><affiliation><nlm:affiliation>Cardiovascular Institute, Hospital Clínico San Carlos, El Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Gutierrez Ibanes, Enrique" sort="Gutierrez Ibanes, Enrique" uniqKey="Gutierrez Ibanes E" first="Enrique" last="Gutiérrez-Ibanes">Enrique Gutiérrez-Ibanes</name><affiliation><nlm:affiliation>CIBERCV, Hospital General Gregorio Marañón and Universidad Carlos III, Madrid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Del Valle, Raquel" sort="Del Valle, Raquel" uniqKey="Del Valle R" first="Raquel" last="Del Valle">Raquel Del Valle</name><affiliation><nlm:affiliation>Hospital Universitario Central de Asturias, Oviedo, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Mu Oz Garcia, Erika" sort="Mu Oz Garcia, Erika" uniqKey="Mu Oz Garcia E" first="Erika" last="Mu Oz-García">Erika Mu Oz-García</name><affiliation><nlm:affiliation>CIBERCV, Hospital Virgen de la Victoria, Málaga, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Jimenez Diaz, Victor A" sort="Jimenez Diaz, Victor A" uniqKey="Jimenez Diaz V" first="Víctor A" last="Jiménez-Diaz">Víctor A. Jiménez-Diaz</name><affiliation><nlm:affiliation>Hospital Universitario de Vigo, Vigo, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Regueiro, Ander" sort="Regueiro, Ander" uniqKey="Regueiro A" first="Ander" last="Regueiro">Ander Regueiro</name><affiliation><nlm:affiliation>Hospital Clinic Univeristari, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Gonzalez Ferreiro, Rocio" sort="Gonzalez Ferreiro, Rocio" uniqKey="Gonzalez Ferreiro R" first="Rocío" last="González-Ferreiro">Rocío González-Ferreiro</name><affiliation><nlm:affiliation>Hospital Clínico Universitario, Salamanca, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Benito, Tomas" sort="Benito, Tomas" uniqKey="Benito T" first="Tomás" last="Benito">Tomás Benito</name><affiliation><nlm:affiliation>Hospital Universitario de León, León, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Sanmartin Pena, Xoan Carlos" sort="Sanmartin Pena, Xoan Carlos" uniqKey="Sanmartin Pena X" first="Xoan Carlos" last="Sanmartin-Pena">Xoan Carlos Sanmartin-Pena</name><affiliation><nlm:affiliation>CIBERCV, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Catala, Pablo" sort="Catala, Pablo" uniqKey="Catala P" first="Pablo" last="Catalá">Pablo Catalá</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Rodriguez Gabella, Tania" sort="Rodriguez Gabella, Tania" uniqKey="Rodriguez Gabella T" first="Tania" last="Rodríguez-Gabella">Tania Rodríguez-Gabella</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Delgado Arana, Jose Raul" sort="Delgado Arana, Jose Raul" uniqKey="Delgado Arana J" first="Jose Raúl" last="Delgado-Arana">Jose Raúl Delgado-Arana</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Carrasco Moraleja, Manuel" sort="Carrasco Moraleja, Manuel" uniqKey="Carrasco Moraleja M" first="Manuel" last="Carrasco-Moraleja">Manuel Carrasco-Moraleja</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Iba Ez, Borja" sort="Iba Ez, Borja" uniqKey="Iba Ez B" first="Borja" last="Iba Ez">Borja Iba Ez</name><affiliation><nlm:affiliation>CIBERCV, Centro Nacional de Investigaciones Cardiovasculares, IIS-Hospital Fundación Jimenez Diaz, Madrid, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="San Roman, J Alberto" sort="San Roman, J Alberto" uniqKey="San Roman J" first="J Alberto" last="San Román">J Alberto San Román</name><affiliation><nlm:affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Journal of the American College of Cardiology</title><idno type="eISSN">1558-3597</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Angiotensin-Converting Enzyme Inhibitors (adverse effects)</term><term>Betacoronavirus (MeSH)</term><term>Coronavirus Infections (chemically induced)</term><term>Coronavirus Infections (mortality)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (chemically induced)</term><term>Pneumonia, Viral (mortality)</term><term>Ramipril (adverse effects)</term><term>Randomized Controlled Trials as Topic (MeSH)</term><term>Risk Factors (MeSH)</term><term>Spain (epidemiology)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Angiotensin-Converting Enzyme Inhibitors</term><term>Ramipril</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Spain</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Betacoronavirus</term><term>Female</term><term>Humans</term><term>Male</term><term>Pandemics</term><term>Randomized Controlled Trials as Topic</term><term>Risk Factors</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory-syndrome coronavirus-2 that interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting enzyme 2. This interaction has been proposed as a potential risk factor in patients treated with RAAS inhibitors.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>This study analyzed whether RAAS inhibitors modify the risk for COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>The RASTAVI (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation) trial is an ongoing randomized clinical trial randomly allocating subjects to ramipril or control groups after successful transcatheter aortic valve replacement at 14 centers in Spain. A non-pre-specified interim analysis was performed to evaluate ramipril's impact on COVID-19 risk in this vulnerable population.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>As of April 1, 2020, 102 patients (50 in the ramipril group and 52 in the control group) were included in the trial. Mean age was 82.3 ± 6.1 years, 56.9% of the participants were male. Median time of ramipril treatment was 6 months (interquartile range: 2.9 to 11.4 months). Eleven patients (10.8%) have been diagnosed with COVID-19 (6 in control group and 5 receiving ramipril; hazard ratio: 1.150; 95% confidence interval: 0.351 to 3.768). The risk of COVID-19 was increased in older patients (p = 0.019) and those with atrial fibrillation (p = 0.066), lower hematocrit (p = 0.084), and more comorbidities according to Society of Thoracic Surgeons score (p = 0.065). Admission and oxygen supply was required in 4.9% of patients (2 in the ramipril group and 3 in the control group), and 4 of them died (2 in each randomized group). A higher body mass index was the only factor increasing the mortality rate (p = 0.039).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In a high-risk population of older patients with cardiovascular disease, randomization to ramipril had no impact on the incidence or severity of COVID-19. This analysis supports the maintenance of RAAS inhibitor treatment during the COVID-19 crisis. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185).</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32470515</PMID><DateCompleted><Year>2020</Year><Month>07</Month><Day>24</Day></DateCompleted><DateRevised><Year>2020</Year><Month>07</Month><Day>24</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1558-3597</ISSN><JournalIssue CitedMedium="Internet"><Volume>76</Volume><Issue>3</Issue><PubDate><Year>2020</Year><Month>07</Month><Day>21</Day></PubDate></JournalIssue><Title>Journal of the American College of Cardiology</Title><ISOAbbreviation>J. Am. Coll. Cardiol.</ISOAbbreviation></Journal><ArticleTitle>Ramipril in High-Risk Patients With COVID-19.</ArticleTitle><Pagination><MedlinePgn>268-276</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0735-1097(20)35395-X</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jacc.2020.05.040</ELocationID><Abstract><AbstractText Label="BACKGROUND">Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory-syndrome coronavirus-2 that interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting enzyme 2. This interaction has been proposed as a potential risk factor in patients treated with RAAS inhibitors.</AbstractText><AbstractText Label="OBJECTIVES">This study analyzed whether RAAS inhibitors modify the risk for COVID-19.</AbstractText><AbstractText Label="METHODS">The RASTAVI (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation) trial is an ongoing randomized clinical trial randomly allocating subjects to ramipril or control groups after successful transcatheter aortic valve replacement at 14 centers in Spain. A non-pre-specified interim analysis was performed to evaluate ramipril's impact on COVID-19 risk in this vulnerable population.</AbstractText><AbstractText Label="RESULTS">As of April 1, 2020, 102 patients (50 in the ramipril group and 52 in the control group) were included in the trial. Mean age was 82.3 ± 6.1 years, 56.9% of the participants were male. Median time of ramipril treatment was 6 months (interquartile range: 2.9 to 11.4 months). Eleven patients (10.8%) have been diagnosed with COVID-19 (6 in control group and 5 receiving ramipril; hazard ratio: 1.150; 95% confidence interval: 0.351 to 3.768). The risk of COVID-19 was increased in older patients (p = 0.019) and those with atrial fibrillation (p = 0.066), lower hematocrit (p = 0.084), and more comorbidities according to Society of Thoracic Surgeons score (p = 0.065). Admission and oxygen supply was required in 4.9% of patients (2 in the ramipril group and 3 in the control group), and 4 of them died (2 in each randomized group). A higher body mass index was the only factor increasing the mortality rate (p = 0.039).</AbstractText><AbstractText Label="CONCLUSIONS">In a high-risk population of older patients with cardiovascular disease, randomization to ramipril had no impact on the incidence or severity of COVID-19. This analysis supports the maintenance of RAAS inhibitor treatment during the COVID-19 crisis. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185).</AbstractText><CopyrightInformation>Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Amat-Santos</LastName><ForeName>Ignacio J</ForeName><Initials>IJ</Initials><AffiliationInfo><Affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain. Electronic address: ijamat@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Santos-Martinez</LastName><ForeName>Sandra</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>López-Otero</LastName><ForeName>Diego</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>CIBERCV, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nombela-Franco</LastName><ForeName>Luis</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Cardiovascular Institute, Hospital Clínico San Carlos, El Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gutiérrez-Ibanes</LastName><ForeName>Enrique</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>CIBERCV, Hospital General Gregorio Marañón and Universidad Carlos III, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Del Valle</LastName><ForeName>Raquel</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Hospital Universitario Central de Asturias, Oviedo, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Muñoz-García</LastName><ForeName>Erika</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>CIBERCV, Hospital Virgen de la Victoria, Málaga, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jiménez-Diaz</LastName><ForeName>Víctor A</ForeName><Initials>VA</Initials><AffiliationInfo><Affiliation>Hospital Universitario de Vigo, Vigo, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Regueiro</LastName><ForeName>Ander</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Hospital Clinic Univeristari, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>González-Ferreiro</LastName><ForeName>Rocío</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Hospital Clínico Universitario, Salamanca, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Benito</LastName><ForeName>Tomás</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Hospital Universitario de León, León, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sanmartin-Pena</LastName><ForeName>Xoan Carlos</ForeName><Initials>XC</Initials><AffiliationInfo><Affiliation>CIBERCV, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Catalá</LastName><ForeName>Pablo</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rodríguez-Gabella</LastName><ForeName>Tania</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Delgado-Arana</LastName><ForeName>Jose Raúl</ForeName><Initials>JR</Initials><AffiliationInfo><Affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Carrasco-Moraleja</LastName><ForeName>Manuel</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ibañez</LastName><ForeName>Borja</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>CIBERCV, Centro Nacional de Investigaciones Cardiovasculares, IIS-Hospital Fundación Jimenez Diaz, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>San Román</LastName><ForeName>J Alberto</ForeName><Initials>JA</Initials><AffiliationInfo><Affiliation>Cardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><DataBankList 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UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>J Am Coll Cardiol. 2020 Jul 21;76(3):277-279</RefSource><PMID Version="1">32674791</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000806" MajorTopicYN="N">Angiotensin-Converting Enzyme Inhibitors</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" 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UI="D017257" MajorTopicYN="N">Ramipril</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016032" MajorTopicYN="N">Randomized Controlled Trials as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013030" MajorTopicYN="N" Type="Geographic">Spain</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">COVID-19</Keyword><Keyword MajorTopicYN="Y">SARS-CoV-2</Keyword><Keyword MajorTopicYN="Y">renin-angiotensin</Keyword><Keyword MajorTopicYN="Y">transcatheter aortic valve replacement</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>04</Month><Day>27</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>05</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>05</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>5</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>7</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>5</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32470515</ArticleId><ArticleId IdType="pii">S0735-1097(20)35395-X</ArticleId><ArticleId IdType="doi">10.1016/j.jacc.2020.05.040</ArticleId><ArticleId IdType="pmc">PMC7250557</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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