Introduction:
Myocardial injury after noncardiac surgery (MINS) is strongly associated with 30-day mortality, and no guidelines exist to address management in this group. We hypothesized that Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blocker (ACEI/ARB) reduces short-term mortality in MINS patients.
Methods:
We used data from the Wake-Up T2MI registry, which is a single-center, retrospective cohort of adults with elevated troponin (cTn) I (>0.04 ng/dL) during hospitalization without acute coronary syndrome in a 2-year period. Kaplan-Meier curve and a multivariate-adjusted Cox-proportional hazard models were performed to assess all-cause mortality at 30-days and 90-days among patients with and without ACEI/ARBs upon discharge.
Results:
A total of 457 MINS patients were included in the final analysis. There were no significant differences in baseline characteristics and peak cTn among patients stratified by ACEI/ARB status. Prevalence of mortality was significantly lower at 30-days (1.4% vs 6.3%, p = 0.025) and non-significantly lower at 90-days (7.9% vs. 12%, p = 0.188) in patients who were discharged on ACEI/ARBs compared to non-ACEI/ARBs. Patients with ACEI/ARBs upon discharge showed a statistically significant survival benefit at 30-days (log-rank p = 0.023) but not at 90-days (log-rank p = 0.150) (Figure 1). In a multivariate-adjusted model, ACEI/ARBs had a HR of 0.172 (CI: 0.037 - 0.823; p = 0.027) at 30 days and HR of 0.497 (CI: 0.240 - 1.030; p = 0.060) at 90 days (Figure 2).
Conclusion:
In conclusion, ACEI/ARBs on discharge were associated with decreased short-term mortality in MINS patients. Further studies are needed to validate our results.
Treatment With Angiotensin-Converting Enzyme Inhibitors Is Associated With a Reduction in Short-Term Mortality in Older Patients With Acute Ischemic Stroke
