title: Impact of preoperative angiotensin-converting enzyme inhibitor use on clinical outcomes after cardiac surgery.
abstract: BACKGROUND
  Controversy exists about whether preoperative angiotensin-converting enzyme inhibitor (ACEi) therapy is associated with adverse outcomes after coronary artery bypass grafting (CABG).
  
  
  METHODS
  We analyzed the outcomes of consecutive patients who underwent isolated CABG between 1998 and 2007 at a single institution. We used multivariable models to examine the association between preoperative ACEi therapy and in-hospital and long-term outcomes.
  
  
  RESULTS
  Of the 5946 patients undergoing isolated CABG during the study period, 3,262 (54.9%) were treated with an ACEi preoperatively and 2,684 (45.1%) were not. Median follow-up was 3.8 years. Patients treated with an ACEi preoperatively were more likely to have diabetes, hypertension, an ejection fraction of less than 40%, and recent myocardial infarction (all p<0.0001). They were less likely to have pre-existing renal failure (p=0.004) or require an urgent or emergent CABG (p=0.03). Postoperative use of an inotrope (26% vs 20%, p<0.0001) or intra-aortic balloon pump (1.8% vs 1.1%, p=0.03) was more frequent in patients treated preoperatively with an ACEi; however, preoperative ACEi use was not an independent predictor of in-hospital mortality (odds ratio [OR], 1.1; p=0.76), prolonged length of stay in the intensive care unit (OR, 0.9; p=0.09), or new-onset renal failure (OR, 0.7; p=0.09). Furthermore, preoperative use of an ACEi had no independent association with long-term survival (p=0.54) or freedom from acute coronary syndrome (p=0.07). However, it was associated with an increased risk of readmission for heart failure over time (hazard ratio, 1.2; p=0.007).
  
  
  CONCLUSIONS
  We found no association between preoperative ACEi therapy and adverse in-hospital outcomes or long-term survival after CABG. Preoperative ACEi therapy appears to be safe in patients undergoing CABG.
authors.affiliation: Division of Cardiac Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. mouzouni@dal.ca
authors.forename: Maral
authors.initials: M
authors.lastname: Ouzounian
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Buth
authors.forename: Liliya
authors.initials: L
authors.lastname: Valeeva
authors.forename: Craig C
authors.initials: CC
authors.lastname: Morton
authors.forename: Ansar
authors.initials: A
authors.lastname: Hassan
authors.forename: Imtiaz S
authors.initials: IS
authors.lastname: Ali
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000453:epidemiology; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009674:Nova Scotia / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors