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Original Articles: Adult Cardiac

Impact of Preoperative Angiotensin-Converting Enzyme Inhibitor Use on Clinical Outcomes After Cardiac Surgery

^a Division of Cardiac Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
^b Department of Cardiac Surgery, New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, New Brunswick, Canada

Accepted for publication October 20, 2011.

^_* Address correspondence to Dr Ouzounian, Queen Elizabeth II Health Sciences Centre, 1796 Summer St, Rm 2263, Halifax, Nova Scotia, B3H 3A7, Canada (Email: mouzouni{at}dal.ca).

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.