{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T22:57:33Z","timestamp":1773701853164,"version":"3.50.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T00:00:00Z","timestamp":1675296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270349"],"award-info":[{"award-number":["82270349"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72274133"],"award-info":[{"award-number":["72274133"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Tianjin Key Medical Discipline","award":["TJYXZDXK-069C"],"award-info":[{"award-number":["TJYXZDXK-069C"]}]},{"DOI":"10.13039\/501100010041","name":"Tianjin Municipal Science and Technology Commission","doi-asserted-by":"publisher","award":["19JCQNJC11500"],"award-info":[{"award-number":["19JCQNJC11500"]}],"id":[{"id":"10.13039\/501100010041","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010104","name":"Tianjin Medical University","doi-asserted-by":"publisher","award":["SYL001-303078100820"],"award-info":[{"award-number":["SYL001-303078100820"]}],"id":[{"id":"10.13039\/501100010104","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010104","name":"Tianjin Medical University","doi-asserted-by":"publisher","award":["SYL002-303078100821"],"award-info":[{"award-number":["SYL002-303078100821"]}],"id":[{"id":"10.13039\/501100010104","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>In acute coronary syndrome (ACS) patients without advanced renal dysfunction [estimated glomerular filtration rate (eGFR) &amp;lt; 30\u00a0mL\/min\/1.73 m2], early (within 24 h of admission) angiotensin-converting enzyme inhibitor\/angiotensin receptor blocker (ACEI\/ARB) is the guideline-directed medical therapy. The clinical efficacy of early ACEI\/ARB therapy among ACS patients with advanced renal dysfunction remains unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Among 184\u2009850 ACS patients hospitalized from July 2014 to December 2018 in the Chinese National Electronic Disease Surveillance System Platform (CNEDSSP) cohort and 113\u2009650 ACS patients enrolled from November 2014 to December 2019 in the Improving Care for Cardiovascular Disease in China-ACS Project (CCC-ACS) cohort, we identified 3288 and 3916 ACS patients with admission eGFR &amp;lt; 30\u00a0mL\/min\/1.73 m2 [2647 patients treated with ACEI\/ARB (36.7%)], respectively. After 1:1 propensity score matching (PSM) in each cohort, Kaplan\u2013Meier analysis showed that early ACEI\/ARB use was associated with a 39% [hazard ratio (HR): 0.61, 95% confidence interval (95% CI): 0.45\u20130.82] and a 34% (HR: 0.66, 95% CI: 0.46\u20130.95) reduction in in-hospital mortality in CNEDSSP and CCC-ACS cohorts, respectively, which was consistent in multiple sensitivity analyses. A random effect meta-analysis of the two cohorts after PSM revealed a 32% reduction (risk ratio: 0.68, 95% CI: 0.55\u20130.84) in in-hospital mortality among ACEI\/ARB users.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Based on two nationwide cohorts in China in contemporary practice, we demonstrated that ACEI\/ARB therapy initiated within 24 h of admission is associated with a reduction in in-hospital mortality in ACS patients with advanced renal dysfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trial registration<\/jats:title>\n                  <jats:p>CCC-ACS project was registered at URL: https:\/\/www.clinicaltrials.gov. (Unique identifier: NCT02306616).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcad006","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T00:50:41Z","timestamp":1675385441000},"page":"785-795","source":"Crossref","is-referenced-by-count":5,"title":["Renin\u2013angiotensin system inhibition and in-hospital mortality in acute coronary syndrome patients with advanced renal dysfunction: findings from CCC-ACS project and a nationwide electronic health record-based cohort in China"],"prefix":"10.1093","volume":"9","author":[{"given":"Zhi","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiology, Tianjin Medical University General Hospital , Tianjin , China"},{"name":"Laboratory for Mechanisms and Therapies of Heart Diseases, School of Pharmacy, Tianjin Medical University , Tianjin , 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China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Tianjin Key Laboratory of Inflammatory Biology, Center for Cardiovascular Diseases, Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University , Tianjin , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing , 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