Evidence map›Paper›PMID 32470515›Full record

ArticleJournal of the American College of Cardiology2020

Ramipril in High-Risk Patients With COVID-19.

Ignacio J Amat-Santos, Sandra Santos-Martinez, Diego López-Otero, Luis Nombela-Franco, Enrique Gutiérrez-Ibanes, Raquel Del Valle, Erika Muñoz-García, Víctor A Jiménez-Diaz, Ander Regueiro, Rocío González-Ferreiro and 8 more

Registry-linked trialOpen access · bronzeAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03201185 (Beneficio Del Bloqueo Del Sistema Renina-angiotensina Sobre la evolución clínica y el Remodelado Ventricular Tras la colocación de Una prótesis percutánea aórtica), which is not on this map. Cited by 42 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 14 pooled it
1.7field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03201185 phase4unknown statusnot on this map

Beneficio Del Bloqueo Del Sistema Renina-angiotensina Sobre la evolución clínica y el Remodelado Ventricular Tras la colocación de Una prótesis percutánea aórtica (RASTAVI)

TypeinterventionalSponsorHospital Clínico Universitario de ValladolidRan2018 to 2023Enrolled194ConditionsTranscatheter Aortic Valve Replacemen, Angiotensin-Converting Enzyme InhibitorsArmsRamipril
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 14 syntheses or guidelines pooled it, 68 citations in OpenAlex.

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  6. Safety and Efficacy of Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19 Population.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors at 7 institutions in 1 country.

Ignacio J Amat-SantosCardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain. Electronic address: ijamat@gmail.com.
Sandra Santos-MartinezCardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.
Diego López-OteroCIBERCV, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
Luis Nombela-FrancoCardiovascular Institute, Hospital Clínico San Carlos, El Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.
Enrique Gutiérrez-IbanesCIBERCV, Hospital General Gregorio Marañón and Universidad Carlos III, Madrid, Spain.
Raquel Del ValleHospital Universitario Central de Asturias, Oviedo, Spain.
Erika Muñoz-GarcíaCIBERCV, Hospital Virgen de la Victoria, Málaga, Spain.
Víctor A Jiménez-DiazHospital Universitario de Vigo, Vigo, Spain.
Ander RegueiroHospital Clinic Univeristari, Barcelona, Spain.
Rocío González-FerreiroHospital Clínico Universitario, Salamanca, Spain.
Tomás BenitoHospital Universitario de León, León, Spain.
Xoan Carlos Sanmartin-PenaCIBERCV, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
Pablo CataláCardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.
Tania Rodríguez-GabellaCardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.
Jose Raúl Delgado-AranaCardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.
Manuel Carrasco-MoralejaCardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.
Borja IbañezCIBERCV, Centro Nacional de Investigaciones Cardiovasculares, IIS-Hospital Fundación Jimenez Diaz, Madrid, Spain.
J Alberto San RománCardiology Department, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.
Centro de Investigación en Red en Enfermedades Cardiovasculares · ESHospital de León · ESHospital General Universitario Gregorio Marañón · ESHospital Universitari de Vic · ESHospital Universitario Central de Asturias · ESInstituto de Investigación Sanitaria del Hospital Clínico San Carlos · ESUniversity Hospital Complex Of Vigo · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCoronavirus 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.

objectivesThis study analyzed whether RAAS inhibitors modify the risk for COVID-19.

methodsThe 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.

resultsAs 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).

conclusionsIn 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).

Indexed as

AgedAged, 80 and overAngiotensin-Converting Enzyme InhibitorsBetacoronavirusCoronavirus InfectionsCOVID-19FemaleHumansMalePandemicsPneumonia, ViralRamiprilRandomized Controlled Trials as TopicRisk FactorsSARS-CoV-2SpainAngiotensin-Converting Enzyme InhibitorsRamiprilCOVID-19renin-angiotensinSARS-CoV-2transcatheter aortic valve replacement

Identifiers

PMID32470515
PMCPMC7250557
OpenAlexW3029048120

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.