Abstract 10779: Preoperative Renin-Angiotensin System Inhibitor Use is Associated with Worse Clinical Outcomes Following Cardiovascular Surgery: Results of a Meta-Analysis
Introduction: Use of renin-angiotensin system (RAS) inhibitors (ACE inhibitors and ARBs) prior to cardiovascular surgery is common yet controversial. RAS inhibitor use has the potential risks of hypotension and kidney injury and the potential benefits of reduced cardiac ischemia and arrhythmia. There is no consensus in the published literature regarding the perioperative risk/benefit of RAS inhibitor use. Hence we sought to evaluate the association between preoperative RAS inhibitor use and postoperative mortality, acute kidney injury (AKI) and atrial fibrillation (AF) by performing a systematic meta-analysis.
Methods: We included all randomized-controlled and observational studies with at least 2 weeks of RAS inhibitor use prior to cardiovascular surgery, and presence of a control group, that reported mortality, AKI or AF as outcomes. Studies prior to February 2011 identified from MEDLINE, Cochrane and NIH databases were included in the analysis. Sensitivity analysis was conducted based on trial design and ventricular function. We used the Mantel-Haenszel fixed effect model for pooling the study results, a random effects model was used for heterogeneous samples/results.
Results: Of 310 published studies, we identified 14 studies (n=37145, mean age 65, 75% male, LVEF range 52-61%) that met criteria for analysis. RAS inhibitor use prior to cardiac surgery was 42% in our study population. In the pooled analysis, preoperative use of RAS inhibitors was found to be associated with increased postoperative mortality and AKI, but not AF (table). Sensitivity analysis was consistent with the overall findings.
Conclusion: Use of RAS inhibitors prior to cardiac surgery is associated with increased likelihood of postoperative mortality and AKI and not protective against AF. It remains to be determined if preoperative discontinuation of RAS inhibitors results in improved clinical outcomes.
- © 2011 by American Heart Association, Inc.