title: The effects of preoperative renin-angiotensin system inhibitors on outcomes in patients undergoing cardiac surgery.
abstract: OBJECTIVE
  The effects of preoperative (pre-op) renin-angiotensin system (RAS) inhibitors on outcomes in patients undergoing cardiac surgery remain uncertain. The aim of this study was to evaluate whether the use of pre-op RAS inhibitors affected major outcomes of cardiac surgery.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  A university teaching hospital.
  
  
  METHODS
  Patients undergoing cardiac surgery between January 1, 2001 and December 31, 2011.
  
  
  METHODS
  One thousand two hundred thirty-nine patients who received pre-op RAS inhibitors were compared with those who did not (control group, n = 1,083).
  
  
  RESULTS
  Acute kidney injury (AKI) was defined using Acute Kidney Injury Network classification. Patients in the RAS inhibitors group presented with higher comorbidities. Pre-op RAS inhibitors therapy was associated with the reduction in the incidence of AKI (27.2% v 34.0%, p<0.001), septicemia (1.9% v 3.5%, p = 0.019), and operative mortality (2.99% v 4.62%, p = 0.039). After adjusted propensity scores and multivariate logistic regression, the pre-op RAS inhibitors were found to have protective effects against AKI (odds ratio [OR]: 0.764, 95% confidence interval [CI]: 0.670-0.873, p<0.001), septicemia (OR: 0.515, 95% CI: 0.348-0.761, p>0.001), and operative mortality (OR: 0.539, 95% CI: 0.348-0.758, p<0.001).
  
  
  CONCLUSIONS
  The results suggested that pre-op RAS inhibitor therapy was associated with significant reductions in the risk of AKI, operative mortality, and septicemia.
authors.affiliation: Department of Anesthesiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
authors.forename: Pengcai
authors.initials: P
authors.lastname: Shi
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Li
authors.forename: Nilas
authors.initials: N
authors.lastname: Young
authors.forename: Fuhai
authors.initials: F
authors.lastname: Ji
authors.forename: Yuelan
authors.initials: Y
authors.lastname: Wang
authors.forename: Peter
authors.initials: P
authors.lastname: Moore
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
mesh_terms: D058186:Acute Kidney Injury / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000032:analysis / Q000378:metabolism; D003422:Critical Care; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D003402:Creatine Kinase
keywords: acute kidney injury; cardiac surgery; renin-angiotensin system inhibitors