@Article{chd.12622,
AUTHOR = {Doris P. Yimgang, John D. Sorkin, Charles F. Evans, Danielle S. Abraham, Geoffrey L. Rosenthal},
TITLE = {Angiotensin converting enzyme inhibitors and interstage failure in infants with hypoplastic left heart syndrome},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {4},
PAGES = {533--540},
URL = {http://www.techscience.com/schd/v13n4/39036},
ISSN = {3071-1738},
ABSTRACT = {<b>Introduction:</b> Angiotensin converting enzyme inhibitors are commonly prescribed medications
after the Norwood procedure. There are little data that can be used to determine if angiotensin
converting enzyme inhibitors improve interstage outcomes in children with single ventricle defects.
The objective of this study was to investigate the relationship between angiotensin converting
enzyme inhibitors and interstage failure among infants born with hypoplastic left heart syndrome.<br/>
<b>Methods:</b> We conducted a retrospective cohort study using data from the National Pediatric Cardiology Quality Improvement Collaborative database (collected between 2008 and 2015). We
used logistic regression models to assess the exposure-outcome associations and propensity score
matching to account for differences in baseline patient characteristics associated with use of
angiotensin converting enzyme inhibitors.<br/>
<b>Results:</b> A total of 1 487 neonates participated in the study. Thirty-nine percent of patients were
prescribed angiotensin converting enzyme inhibitors after the Norwood procedure; 11% experienced interstage failure (death, heart transplantation, and not being a candidate for the secondstage surgery). Before propensity score matching, patients receiving angiotensin converting
enzyme inhibitors were significantly more likely to experience interstage failure, compared to
patients not on angiotensin converting enzyme inhibitors (OR = 1.44; 95% CI: 1.04, 1.99;
P = 0.03). Although there was an increased odds of interstage failure among patients receiving
angiotensin converting enzyme inhibitors compared to patients not receiving angiotensin converting enzyme inhibitors in the propensity score-matched cohort, this association was not
significantly different (adjusted OR = 1.29; 95% CI: 0.88, 1.95; = 5 0.18).<br/>
<b>Conclusion:</b> Angiotensin converting enzyme inhibitor therapy did not demonstrate a beneficial
effect on interstage failure among infants with hypoplastic left heart syndrome, even when patient
characteristics associated with the use of angiotensin converting enzyme inhibitors were considered.},
DOI = {10.1111/chd.12622}
}