Preoperative ACE inhibitor use increased the requirement for at least two vasoconstrictor infusions after cardiopulmonary bypass compared to non-use (7.7% vs 4.0%; P=0.0001).
Cohort (n=4,301)
Does chronic preoperative ACE inhibitor use increase the requirement for vasoconstrictor therapy after cardiopulmonary bypass in adults undergoing elective cardiac surgery?
Preoperative ACE inhibitor use is an independent risk factor for requiring multiple vasoconstrictor infusions to treat hypotension after cardiopulmonary bypass.
Absolute Event Rate: 7.7% vs 4%
p-value: p=0.0001
Preoperative use of angiotensin-converting enzyme (ACE) inhibitors is common and has been associated with hypotension at separation from cardiopulmonary bypass (CPB). This study prospectively examined the influence of chronic preoperative ACE inhibitor use and other perioperative factors on the incidence of vasoconstrictor therapy required to maintain systolic blood pressure at more than 85 mm Hg despite a normal cardiac output after CPB in 4301 adults undergoing elective coronary artery and/or valve surgery. Hypothermic, nonpulsatile CPB and either opioid or ketamine-benzodiazepine anesthesia were common features of the operations. At least two vasoconstrictor infusions (phenylephrine, norepinephrine, or dopamine) were required for low perfusion pressure despite adequate cardiac output after CPB in 7.7% of 519 ACE-inhibited patients and 4.0% of 3782 patients not receiving ACE inhibitors (P = 0.0001). In the first 4 h after arrival in the intensive care unit, the need for vasoconstrictor infusions to treat hypotension with adequate cardiac output did not differ, although more ACE-inhibited patients (6.4%) exhibited low values of systemic vascular resistance ( or = 2 vasoconstrictor infusions after CPB. No other preoperative drug therapy significantly altered this outcome.
Tuman et al. (1995) conducted a cohort in Elective coronary artery and/or valve surgery (n=4,301). Preoperative ACE inhibitor use vs. No preoperative ACE inhibitor use was evaluated on Requirement of at least two vasoconstrictor infusions for low perfusion pressure despite adequate cardiac output after cardiopulmonary bypass (p=0.0001). Preoperative ACE inhibitor use increased the requirement for at least two vasoconstrictor infusions after cardiopulmonary bypass compared to non-use (7.7% vs 4.0%; P=0.0001).