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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Article info
Publication history
Published online: June 22, 2012
Accepted:
May 23,
2012
Received in revised form:
May 23,
2012
Received:
February 11,
2012
Footnotes
Dr. Virani is supported by a Department of Veterans Affairs Health Services Research and Development Service Career Development Award.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
