2026-06-14T03:52:14Zhttps://repisalud.isciii.es/rest/oai/request

oai:repisalud.isciii.es:20.500.12105/110692024-09-27T08:25:24Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605

00925njm 22002777a 4500 dc Amat-Santos, Ignacio J author Santos-Martinez, Sandra author López-Otero, Diego author Nombela-Franco, Luis author Gutiérrez-Ibanes, Enrique author Del Valle, Raquel author Muñoz-García, Erika author Jiménez-Diaz, Víctor A author Regueiro, Ander author González-Ferreiro, Rocío author Benito, Tomás author Sanmartin-Pena, Xoan Carlos author Catalá, Pablo author Rodríguez-Gabella, Tania author Delgado-Arana, Jose Raúl author Carrasco-Moraleja, Manuel author Ibáñez, Borja author San Román, J Alberto author 2020-07 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). J Am Coll Cardiol. 2020; 76(3):268-76 10.1016/j.jacc.2020.05.040 1558-3597 Journal of the American College of Cardiology 32470515 http://hdl.handle.net/20.500.12105/11069 Ramipril in High-Risk Patients With COVID-19.