Background:
The association between pre-operative use of angiotensin converting enzyme inhibitors (ACEI) and outcomes after coronary artery bypass grafting (CABG) remains controversial. Our aim was to study in-hospital outcomes after isolated CABG in patients on preoperative ACEI.
Methods:
We performed a retrospective analysis of 8,889 patients who underwent isolated CABG from year 2000 to 2011. Primary outcome was the incidence of major adverse events (MAE) defined as a composite of in-hospital mortality, post-operative renal dysfunction, myocardial infarction, stroke, and atrial fibrillation during index hospitalization. Secondary outcomes studied were the incidence of individual components comprising MAE. Logistic regression analysis was performed.
Results (Table):
Of the 8,889 patients, 3,983 (45%) were on pre-operative ACEI (“ACEI group”) and 4906 (55%) were not (“no ACEI group”). The overall incidence of MAE was 38.1% (n=1518) in the “ACEI group” versus 33.6% (n=1649) in “no ACEI group”. Pre-operative ACEI use was independently associated with increased risk of MAE (OR; 1.12, 95% CI; 1.02-1.23), most of which was driven by a statistically significant increase in post-operative renal dysfunction and atrial fibrillation. Pre-operative ACEI therapy was not associated with in-hospital mortality, post-operative myocardial infarction, or stroke.
Conclusion:
Preoperative ACEI use was associated with an increased risk of MAE post CABG, in particular post-operative renal dysfunction and atrial fibrillation.
Association between serum angiotensin-converting enzyme 2 levels and postoperative myocardial infarction following coronary artery bypass grafting
