Key result
Preoperative use of renin-angiotensin system inhibitors significantly reduced 30-day mortality (OR 0.69) compared to no preoperative use in patients undergoing cardiac surgery.
Why the study?
The perioperative use of renin-angiotensin system inhibitors and their effects on outcomes in patients undergoing cardiac surgery remain disputable.
Does perioperative use of renin-angiotensin system inhibitors (RASi) reduce mortality in patients undergoing cardiac surgery?
Cohort (n=8,581)
Yes
Does perioperative use of renin-angiotensin system inhibitors (RASi) reduce mortality in patients undergoing cardiac surgery?
Effect estimate: OR 0.69 (95% CI 0.54-0.90)
Absolute Event Rate: 3.41% vs 5.02%
p-value: p=0.01
Perioperative use of renin-angiotensin system inhibitors is associated with significant improvements in both 30-day and long-term survival among patients undergoing cardiac surgery.
Preoperative RASi was associated with lower 30-day mortality after cardiac surgery; leaves open whether RCTs should test perioperative use.
It remains disputable about perioperative use of renin-angiotensin system inhibitors (RASi) and their outcome effects. This multicenter retrospective cohort study examines association between use of perioperative RASi and outcomes in patients undergoing coronary artery bypass graft and/or valve surgery. After the exclusion, the patients are divided into 2 groups with or without preoperative RASi (PreRASi, n = 8581), or 2 groups with or without postoperative RASi (PostRASi, n = 8130). With using of propensity scores matching to reduce treatment selection bias, the study shows that PreRASi is associated with a significant reduction in postoperative 30-day mortality compared with without one (3.41% vs. 5.02%); PostRASi is associated with reduced long-term mortality rate compared with without one (6.62% vs. 7.70% at 2-year; 17.09% vs. 19.95% at 6-year). The results suggest that perioperative use of RASi has a significant benefit for the postoperative and long-term survival among patients undergoing cardiac surgery.
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Ding et al. (2019) conducted a cohort in Coronary artery bypass graft (CABG) and/or valve surgery (n=8,581). Preoperative renin-angiotensin system inhibitors (RASi) vs. No preoperative RASi was evaluated on 30-day mortality (OR 0.69, 95% CI 0.54-0.90, p=0.01). Preoperative use of renin-angiotensin system inhibitors significantly reduced 30-day mortality (OR 0.69) compared to no preoperative use in patients undergoing cardiac surgery.
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