title: Should all patients be treated with an angiotensin-converting enzyme inhibitor after coronary artery bypass graft surgery? The impact of angiotensin-converting enzyme inhibitors, statins, and β-blockers after coronary artery bypass graft surgery.
abstract: BACKGROUND
  We sought to evaluate the association between angiotensin-converting enzyme (ACE) inhibitors and outcomes after coronary artery bypass graft surgery (CABG).
  
  
  METHODS
  Postoperative outpatient utilization of ACE inhibitors, statins, and β-blockers was assessed in a cohort of 3,718 patients after CABG 65 years and older. The primary outcome was freedom from a composite of all-cause mortality or hospital readmission for cardiac events or procedures.
  
  
  RESULTS
  Use of all 3 medication classes increased significantly over the study period. Female patients and patients with a history of myocardial infarction, diabetes, and poor left ventricular function were independently associated with ACE inhibitor use on multivariate analysis (all P < .05). At a median follow-up of 3 years, postoperative therapy with an ACE inhibitor had no effect on death or rehospitalization for cardiovascular events (adjusted hazard ratio [HR] 1.12, 95% CI 0.96-1.30, P = .16). However, statins (HR 0.65, 95% CI 0.57-0.74, P < .0001) and β-blockers (HR 0.83, 95% CI 0.74-0.93, P = .001) were associated with a significantly improved event-free survival.
  
  
  CONCLUSIONS
  Among patients after CABG 65 years or older, ACE inhibitors had no independent effect on mortality or recurrent ischemic events in the midterm after CABG, although a benefit was observed for statins and β-blockers.
authors.affiliation: Division of Cardiac Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Kalavrouziotis
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Buth
authors.forename: Jafna L
authors.initials: JL
authors.lastname: Cox
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Baskett
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D009674:Nova Scotia; D010359:Patient Readmission; D011183:Postoperative Complications / Q000188:drug therapy* / Q000401:mortality; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors