BACKGROUND: Controversy exists about whether preoperative angiotensin-converting enzyme inhibitor (ACEi) therapy is associated with adverse outcomes after coronary artery bypass grafting (CABG). METHODS: We analyzed the outcomes of consecutive patients who underwent isolated CABG between 1998 and 2007 at a single institution. We used multivariable models to examine the association between preoperative ACEi therapy and in-hospital and long-term outcomes. RESULTS: Of the 5946 patients undergoing isolated CABG during the study period, 3,262 (54.9%) were treated with an ACEi preoperatively and 2,684 (45.1%) were not. Median follow-up was 3.8 years. Patients treated with an ACEi preoperatively were more likely to have diabetes, hypertension, an ejection fraction of less than 40%, and recent myocardial infarction (all p<0.0001). They were less likely to have pre-existing renal failure (p=0.004) or require an urgent or emergent CABG (p=0.03). Postoperative use of an inotrope (26% vs 20%, p<0.0001) or intra-aortic balloon pump (1.8% vs 1.1%, p=0.03) was more frequent in patients treated preoperatively with an ACEi; however, preoperative ACEi use was not an independent predictor of in-hospital mortality (odds ratio [OR], 1.1; p=0.76), prolonged length of stay in the intensive care unit (OR, 0.9; p=0.09), or new-onset renal failure (OR, 0.7; p=0.09). Furthermore, preoperative use of an ACEi had no independent association with long-term survival (p=0.54) or freedom from acute coronary syndrome (p=0.07). However, it was associated with an increased risk of readmission for heart failure over time (hazard ratio, 1.2; p=0.007). CONCLUSIONS: We found no association between preoperative ACEi therapy and adverse in-hospital outcomes or long-term survival after CABG. Preoperative ACEi therapy appears to be safe in patients undergoing CABG.
BACKGROUND: Controversy exists about whether preoperative angiotensin-converting enzyme inhibitor (ACEi) therapy is associated with adverse outcomes after coronary artery bypass grafting (CABG). METHODS: We analyzed the outcomes of consecutive patients who underwent isolated CABG between 1998 and 2007 at a single institution. We used multivariable models to examine the association between preoperative ACEi therapy and in-hospital and long-term outcomes. RESULTS: Of the 5946 patients undergoing isolated CABG during the study period, 3,262 (54.9%) were treated with an ACEi preoperatively and 2,684 (45.1%) were not. Median follow-up was 3.8 years. Patients treated with an ACEi preoperatively were more likely to have diabetes, hypertension, an ejection fraction of less than 40%, and recent myocardial infarction (all p<0.0001). They were less likely to have pre-existing renal failure (p=0.004) or require an urgent or emergent CABG (p=0.03). Postoperative use of an inotrope (26% vs 20%, p<0.0001) or intra-aortic balloon pump (1.8% vs 1.1%, p=0.03) was more frequent in patients treated preoperatively with an ACEi; however, preoperative ACEi use was not an independent predictor of in-hospital mortality (odds ratio [OR], 1.1; p=0.76), prolonged length of stay in the intensive care unit (OR, 0.9; p=0.09), or new-onset renal failure (OR, 0.7; p=0.09). Furthermore, preoperative use of an ACEi had no independent association with long-term survival (p=0.54) or freedom from acute coronary syndrome (p=0.07). However, it was associated with an increased risk of readmission for heart failure over time (hazard ratio, 1.2; p=0.007). CONCLUSIONS: We found no association between preoperative ACEi therapy and adverse in-hospital outcomes or long-term survival after CABG. Preoperative ACEi therapy appears to be safe in patients undergoing CABG.
Authors: Steven G Coca; Amit X Garg; Madhav Swaminathan; Susan Garwood; Kwangik Hong; Heather Thiessen-Philbrook; Cary Passik; Jay L Koyner; Chirag R Parikh Journal: Nephrol Dial Transplant Date: 2013-09-29 Impact factor: 5.992
Authors: Raphael Wurm; Martin Huelsmann; Marius Hienert; Veronika Seidl; Dominik Wiedemann; Guenther Laufer; Alfred Kocher; Christopher Adlbrecht; Martin Andreas Journal: Sci Rep Date: 2017-11-02 Impact factor: 4.379
Authors: Alparslan Turan; Martin Grady; Jing You; Edward J Mascha; Worasak Keeyapaj; Ryu Komatsu; C Allen Bashour; Daniel I Sessler; Leif Saager; Andrea Kurz Journal: PLoS One Date: 2013-05-28 Impact factor: 3.240
Authors: Mitesh Shah; Arsh K Jain; Steven M Brunelli; Steven G Coca; Philip J Devereaux; Matthew T James; Jin Luo; Amber O Molnar; Marko Mrkobrada; Neesh Pannu; Chirag R Parikh; Michael Paterson; Salimah Shariff; Ron Wald; Michael Walsh; Richard Whitlock; Duminda N Wijeysundera; Amit X Garg Journal: BMC Nephrol Date: 2014-04-02 Impact factor: 2.388