RT Journal Article
T1 Ramipril in High-Risk Patients With COVID-19.
A1 Amat-Santos, Ignacio J
A1 Santos-Martinez, Sandra
A1 López-Otero, Diego
A1 Nombela-Franco, Luis
A1 Gutiérrez-Ibanes, Enrique
A1 Del Valle, Raquel
A1 Muñoz-García, Erika
A1 Jiménez-Diaz, Víctor A
A1 Regueiro, Ander
A1 González-Ferreiro, Rocío
A1 Benito, Tomás
A1 Sanmartin-Pena, Xoan Carlos
A1 Catalá, Pablo
A1 Rodríguez-Gabella, Tania
A1 Delgado-Arana, Jose Raúl
A1 Carrasco-Moraleja, Manuel
A1 Ibañez, Borja
A1 San Román, J Alberto
K1 COVID-19
K1 SARS-CoV-2
K1 renin-angiotensin
K1 transcatheter aortic valve replacement
AB 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. This study analyzed whether RAAS inhibitors modify the risk for COVID-19. 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. 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). 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).
YR 2020
FD 2020-05-26
LK http://hdl.handle.net/10668/15657
UL http://hdl.handle.net/10668/15657
LA en
DS RISalud
RD Apr 9, 2025