title: The use of inhibitors of angiotensin-converting enzyme and its relation to events in the postoperative period of CABG.
abstract: BACKGROUND
  Angiotensin-converting enzyme (ACE) inhibitors reduce the chance of death, myocardial infarction (MI) and cerebrovascular accident (CVA) in patients with coronary disease. However there is no consensus as to its indication in patients undergoing coronary artery bypass grafting (CABG).
  
  
  OBJECTIVE
  To assess the relationship between preoperative use of ACE inhibitors and clinical outcomes after CABG.
  
  
  METHODS
  Retrospective cohort study. We included data from 3,139 consecutive patients undergoing isolated CABG in Brazilian tertiary care hospital between January 1996 and December 2009. Follow-up was until discharge or death. Clinical outcomes after surgery were analyzed between users and nonusers of ACE inhibitors preoperatively.
  
  
  RESULTS
  Fifty-two percent (n=1,635) of patients received ACE inhibitors preoperatively. The use of ACE inhibitors was an independent predictor of need for inotropic support (OR 1.24, 95% CI 1.01 to 1.47, P = 0.01), acute renal failure (OR 1.23, 95% CI 1.01 to 1.73, P = 0.04) and progression to atrial fibrillation (OR 1.32, 95% CI 1.02 to 1.7, P = 0.03) postoperatively. The mortality rate among patients receiving or not preoperative ACE inhibitors was similar (10.3% vs. 9.4%, P = 0.436), as well as the incidence of myocardial infarction and stroke (15.6% vs. 15.0%, P = 0.694 and 3.4% vs. 3.5%, P = 0.963, respectively).
  
  
  CONCLUSIONS
  The use of preoperative ACE inhibitors was associated with increased need for inotropic support and higher incidence of acute renal failure and postoperative atrial fibrillation, not associated with increased rates of myocardial infarction, stroke or death.
authors.affiliation: Institute of Cardiology of Rio Grande do Sul, Porto Alegre, RS, Brasil. gracianeradaelli@yahoo.com.br
authors.forename: Graciane
authors.initials: G
authors.lastname: Radaelli
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Bodanese
authors.forename: João Carlos Vieira da Costa
authors.initials: JC
authors.lastname: Guaragna
authors.forename: Anibal Pires
authors.initials: AP
authors.lastname: Borges
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Goldani
authors.forename: João Batista
authors.initials: JB
authors.lastname: Petracco
authors.forename: Jacqueline da Costa Escobar
authors.initials: Jda C
authors.lastname: Piccoli
authors.forename: Luciano Cabral
authors.initials: LC
authors.lastname: Albuquerque
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000139:chemically induced; D002316:Cardiotonic Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents