Heart Care Info - Heart Disease Prevention & Treatment

Impact of Preoperative Angiotensin-Converting Enzyme Inhibitor Use on Clinical Outcomes After Cardiac Surgery

M Ouzounian, KJ Buth, L Valeeva... - The Annals of ..., 2012 - Soc Thorac Surgeons 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 ...

Maral Ouzounian, M Da,*, Karen J. Buth, M Sa, Liliya Valeeva, M Da, Craig C. Morton, M Sa, Ansar Hassan, MD, Ph Db, Imtiaz S. Ali, M Da

Accepted for publication October 20, 2011.

Background: Controversy exists about whether preoperative angiotensin-converting enzyme inhibitor (AC Ei) therapy is associated with adverse outcomes after coronary artery bypass grafting (CABG).

Results: Of the 5946 patients undergoing isolated CABG during the study period, 3,262 (54.9%) were treated with an AC Ei preoperatively and 2,684 (45.1%) were not. Median follow-up was 3.8 years. Patients treated with an AC Ei 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 AC Ei; however, preoperative AC Ei 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 AC Ei 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).