Key result
Post-CABG ARBs show comparable MACCE risk to ACE inhibitors.
Why the study?
Although ARBs are an alternative for patients with ACEi intolerance, the comparative effectiveness of ARBs and ACEi remains controversial after CABG.
Does ARB therapy improve or reduce major adverse cardiovascular and cerebrovascular events compared to ACEi in patients who underwent CABG?
Cohort (n=1,198)
No
Does ARB therapy improve or reduce major adverse cardiovascular and cerebrovascular events compared to ACEi in patients who underwent CABG?
Hazard Ratio: 0.65 (95% CI 0.36–1.21)
Absolute Event Rate: 9.6% vs 12.2%
p-value: p=0.17
ARBs provide comparable long-term cardiovascular protection to ACE inhibitors after CABG, with potentially greater benefits in the first 12 months, supporting their use as a safe alternative for ACEi-intolerant patients.
ARBs may offer comparable post-CABG protection to ACEi; leaves open time-dependent effects and requires randomized trials before practice change.
Although angiotensin receptor blockers (ARBs) are considered as an alternative for those with angiotensin converting enzyme inhibitors (ACEi) intolerance, the comparative effectiveness of ARBs and ACEi remains controversial in patients who underwent coronary artery bypass grafting (CABG). We aimed to compare the clinical effects of the two types of renin-angiotensin-aldosterone system (RAAS) inhibitors in patients who underwent CABG. From January 2001 to January 2015, among the 5456 patients, data from 1198 (20.1%) patients who used a RAAS inhibitor at discharge were analyzed. These 1198 patients were classified into ACEi (N = 900) and ARB (N = 298) groups. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE) during a median follow-up period of 48 months. Propensity-matched analysis revealed that the incidence of MACCE over a 48 month follow-up period did not differ between the groups (HR, 0.65; 95% CI, 0.36-1.21; p = 0.17), but it was significantly lower in the ARB group during the 12 month follow-up period (HR, 0.46; 95% CI, 0.22-0.96; p = 0.04). In conclusion, ARBs may have comparable protective effects to ACEi and be a reasonable alternative for intolerant patients after CABG. The beneficial effects of ARBs depending on follow-up period require further investigation.
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Kim et al. (2020) conducted a cohort in Coronary artery bypass grafting (CABG) (n=1,198). Angiotensin Receptor Blockers (ARBs) vs. Angiotensin Converting Enzyme inhibitors (ACEi) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) during a median follow-up period of 48 months (HR 0.65, 95% CI 0.36-1.21, p=0.17). Postoperative use of ARBs after coronary artery bypass grafting showed comparable clinical effects to ACE inhibitors regarding major adverse cardiovascular and cerebrovascular events over a 48-month follow-up (HR 0.65).
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