Author + information
- Received February 13, 2009
- Revision received June 29, 2009
- Accepted July 8, 2009
- Published online November 3, 2009.
- Antonio Miceli, MD,
- Radek Capoun, MD,
- Carlo Fino, MD,
- Pradeep Narayan, MD,
- Alan J. Bryan, MD,
- Gianni D. Angelini, MD, MCh and
- Massimo Caputo, MD, MCh⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Massimo Caputo, Bristol Heart Institute, Cardiac Surgery, Level/Upper Maudlin Street, Bristol BS2 8HW, United Kingdom
This paper was presented at the 58th Annual Scientific Session of the American College of Cardiology, March 28 to 31, 2009, Orlando, Florida.
Objectives This study evaluates the effect of pre-operative angiotensin-converting enzyme inhibitor (ACEI) therapy on early clinical outcomes after coronary artery bypass grafting (CABG).
Background Therapy with ACEIs has been shown to reduce the rate of mortality and prevent cardiovascular events in patients with coronary artery disease. However, their pre-operative use in patients undergoing CABG is still controversial.
Methods A retrospective, observational, cohort study was undertaken of prospectively collected data on 10,023 consecutive patients undergoing isolated CABG between April 1996 and May 2008. Of these, 3,052 patients receiving pre-operative ACEI were matched to a control group by propensity score analysis.
Results Overall rate of mortality was 1%. Pre-operative ACEI therapy was associated with a doubling in the risk of death (1.3% vs. 0.7%; odds ratio [OR]: 2.00, 95% confidence interval [CI]: 1.17 to 3.42; p = 0.013). There was also a significant difference between the ACEI and control group in the risk of post-operative renal dysfunction (PRD) (7.1% vs. 5.4%; OR: 1.36, 95% CI: 1.1 to 1.67; p = 0.006), atrial fibrillation (AF) (25% vs. 20%; OR: 1.34, 95% CI: 1.18 to 1.51; p < 0.0001), and increased use of inotropic support (45.9% vs. 41.1%; OR: 1.22, 95% CI: 1.1 to 1.36; p < 0.0001). In a multivariate analysis, pre-operative ACEI treatment was an independent predictor of mortality (p = 0.04), PRD (p = 0.0002), use of inotropic drugs (p < 0.0001), and AF (p < 0.0001).
Conclusions Pre-operative therapy with ACEI is associated with an increased risk of mortality, use of inotropic support, PRD, and new onset of post-operative AF.
- Received February 13, 2009.
- Revision received June 29, 2009.
- Accepted July 8, 2009.
- American College of Cardiology Foundation