Impact of Angiotensin-converting enzyme inhibitors and Angiotensin receptor blockers on mortality of coronary artery bypass grafting

• Published in: The journal of Tehran Heart Center Vol. 8; no. 4; pp. 177 - 181
• Main Authors: Sharafi, Ahmad, Davoodi, Saeed, Karimi, Abbas Ali, Ahmadi, Hosein, Abbasi, Kyomars, Sheikh Fathollahi, Mahmood, Bina, Payvand, Soleymanzadeh, Maryam, Fehri, Arezoo, Davaran, Saeid, Jahangheeri, Siroos, Kassaian, Seyed Ebrahim
• Format: Journal Article
• Language: English
• Published: Iran Tehran University of Medical Sciences 28.10.2013
• Subjects: Medical Sciences; Angiotensin-converting enzyme inhibitors; Hospital mortality; Coronary artery bypass; Outcome assessment (health care)
• ISSN: 1735-5370; 2008-2371

There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as regards the postoperative mortality of coronary artery bypass grafting (CABG). This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 (46.38%) patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. The mean age of the patients was 60.04 ± 9.51 years and 7364 (73.23%) were male. Eighty-seven (0.86%) patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths inasmuch as there were 33 (0.70%) vs. 54 (1.0%) deaths in the ACEI/ARB positive and negative groups, respectively (OR: 0.628; p value = 0.09). Patients without ACEI/ARB were more likely to have a higher global ejection fraction. Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested.