title: Meta-analysis of the effects of preoperative renin-angiotensin system inhibitor therapy on major adverse cardiac events in patients undergoing cardiac surgery.
abstract: The purpose of this meta-analysis was to assess the role of preoperative renin-angiotensin system inhibitor (RASI) therapy on major adverse cardiac events (MACE) in patients undergoing cardiac surgery. The Medline, Cochrane Library and Embase databases were searched for clinical studies published up to May 2014. Studies that evaluated the effects of preoperative RASI therapy in cardiac surgery were included. Odds ratio (OR) estimates were generated under a random-effects model. After a literature search in the major databases, 18 studies were identified [three randomized prospective clinical trials (RCTs) and 15 observational trials] that reported outcomes of 54 528 cardiac surgery patients with (n = 22 661; 42%) or without (n = 31 867; 58%) preoperative RASI therapy. Pool analysis indicated that preoperative RASI therapy was not associated with a significant reduction of early all-cause mortality [OR: 1.01; 95% confidence interval (CI) 0.88-1.15, P = 0.93; I(2) = 25%], myocardial infarction (OR: 1.04; 95% CI 0.91-1.19, P = 0.60; I(2) = 16%), or stroke (OR: 0.93; 95% CI 0.75-1.14, P = 0.46; I(2) = 38%). Meta-regression analysis confirmed that there was a strong negative correlation between the percentage of diabetics and early all-cause mortality (P = 0.03). Furthermore, preoperative RASI therapy significantly reduced mortality in studies containing a high proportion of diabetic patients (OR: 0.84; 95% CI 0.71-0.99, P = 0.04; I(2) = 0%). In conclusion, our meta-analysis indicated that although preoperative RASI therapy was not associated with a lower risk of MACE in cardiac surgery patients, it might provide benefits for diabetic patients.
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China.
authors.forename: Xiaocheng
authors.initials: X
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China Department of Respirology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Tong
authors.affiliation: Department of Clinical Laboratory, The Third People's Hospital of Chongqing, Chongqing, China.
authors.forename: Qiongwen
authors.initials: Q
authors.lastname: Hu
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China Cardiology/Medicine, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China.
authors.forename: Yuehui
authors.initials: Y
authors.lastname: Yin
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China liuzeng666@163.com.
authors.forename: Zengzhang
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control*; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: CABG; Cardiac surgery; Meta-analysis; Mortality; RASI