Perioperative use of renin-angiotensin system inhibitors and outcomes in patients undergoing cardiac surgery

This study examined association between use of perioperative renin-angiotensin system inhibitors (RASi) and outcomes in patients undergoing coronary artery bypass graft (CABG) and/or valve surgery. Of all the patients, 8,112 patients met inclusion criteria and were divided into four groups: with or without preoperative (PreRASi) or postoperative RASi (PostRASi) respectively. With the use of propensity scores matching and sensitivity analyses to reduce treatment selection bias, this cohort study showed that PreRASi was associated with a significant reduction in postoperative 30-day mortality compared with without one (3.41% vs. 5.02%, OR 0.69, 95% CI 0.54 – 0.90, P=0.01); PostRASi was associated with reduced long-term mortality rate compared with without one (3.66% vs. 4.86%, RR 0.75, 95% CI 0.57 – 0.93 at 1 year; 17.12% vs. 19.91%, RR 0.86, 95% CI 0.75 – 0.97 at 6 year; P= 0.0250 respectively). The results suggest that perioperative use of RASi has a significant benefit for the postoperative and long-term survival among patients undergoing cardiac surgery.