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Outcomes of Preoperative Angiotensin-Converting Enzyme Inhibitor Therapy in Patients Undergoing Isolated Coronary Artery Bypass Grafting

  • Salman J. Bandeali
    Correspondence
    Corresponding author: Tel: 713-533-2509; fax: 713-748-7359
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, Texas
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  • Waleed T. Kayani
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, Texas
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  • Vei-Vei Lee
    Affiliations
    Department of Epidemiology and Biostatistics, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas
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  • Wei Pan
    Affiliations
    Department of Cardiovascular Anesthesiology, Texas Heart Institute, Houston, Texas
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  • Mac Arthur A. Elayda
    Affiliations
    Department of Epidemiology and Biostatistics, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas
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  • Vijay Nambi
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
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  • Hani M. Jneid
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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  • Mahboob Alam
    Affiliations
    Section of Cardiology, Department of Medicine, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
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  • James M. Wilson
    Affiliations
    Section of Cardiology, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas
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  • Yochai Birnbaum
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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  • Christie M. Ballantyne
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
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  • Salim S. Virani
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas

    Health Policy and Quality Program, Michael E. DeBakey Veteran Affairs Medical Center Health Services Research and Development Center of Excellence, Houston, Texas

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas

    Section of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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      The association between preoperative use of angiotensin-converting enzyme (ACE) inhibitors and outcomes after coronary artery bypass grafting (CABG) remain controversial. Our aim was to study in-hospital outcomes after isolated CABG in patients on preoperative ACE inhibitors. A retrospective analysis of 8,889 patients who underwent isolated CABG from 2000 through 2011 was conducted. The primary outcome of interest was the incidence of major adverse events (MAEs) defined as a composite of mortality, postoperative renal dysfunction, myocardial infarction, stroke, and atrial fibrillation during index hospitalization. The secondary outcome was the incidence of individual outcomes included in MAEs. Logistic regression analyses were performed. Of 8,889 patients, 3,983 (45%) were on preoperative ACE inhibitors and 4,906 (55%) were not. Overall incidence of MAEs was 38.1% (n = 1,518) in the ACE inhibitor group compared to 33.6% (n = 1,649) in the no-ACE inhibitor group. Preoperative use of ACE inhibitors was independently associated with MAEs (odds ratio 1.13, 95% confidence interval 1.03 to 1.24), most of which was driven by a statistically significant increase in postoperative renal dysfunction (odds ratio 1.18, 95% confidence interval 1.03 to 1.36) and atrial fibrillation (odds ratio 1.15, 95% confidence interval 1.05 to 1.27). In-hospital mortality, postoperative myocardial infarction, and stroke were not significantly associated with preoperative ACE inhibitor use. Analyses performed after excluding patients with low ejection fractions yielded similar results. In conclusion, preoperative ACE inhibitor use was associated with an increased risk of MAEs after CABG, in particular postoperative renal dysfunction and atrial fibrillation.
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