Outcomes of Preoperative Angiotensin-Converting Enzyme Inhibitor Therapy in Patients Undergoing Isolated Coronary Artery Bypass Grafting

Bandeali, Salman; Kayani, Waleed T.; Lee, Vei-Vei; Pan, Wei; Elayda, Mac Arthur A.; Nambi, Vijay; Jneid, Hani; Alam, Mahboob; Wilson, James M.; Birnbaum, Yochai; Ballantyne, Christie M.; Virani, Salim S.

doi:10.1016/j.amjcard.2012.05.021

Cited by 36 publications

(19 citation statements)

References 26 publications

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“…The association between high BUN levels and worse outcome in patients undergoing CABG was also suggested in the American College of Surgeons National Surgical Quality Improvement Program database [26]. Several studies, including meta-analyses, have shown that the perioperative use of ACE-I was associated with adverse events following CABG [27,28].…”

Section: Discussionmentioning

confidence: 94%

Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery

et al. 2016

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Section: Discussionmentioning

confidence: 94%

Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery

et al. 2016

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“…Consequently, 11 unique studies characterizing a total of 27 885 unique patients (median age, 65 years [range, 58.5-74.5 years]; 74.4% male and 25.6% female) were selected into our meta-analysis. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 The baseline characteristics of included studies are summarized in Table 1 , and quality assessment for included trials is presented in eTable 1 in the Supplement . Outcome data of included studies were extracted and are detailed in eTable 2 in the Supplement .…”

Section: Resultsmentioning

confidence: 99%

Association of Preoperative Renin-Angiotensin System Inhibitors With Prevention of Postoperative Atrial Fibrillation and Adverse Events

et al. 2019

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Key Points Question Does the use of renin-angiotensin system inhibitors have any association with reduction in atrial fibrillation and adverse events for patients undergoing cardiac surgery? Findings This systematic review and meta-analysis involving 11 unique studies with 27 885 patients undergoing cardiac surgery found no additional association between preoperative renin-angiotensin system inhibitor therapy and a reduced risk of postoperative atrial fibrillation, stroke, death, or hospitalization. Meaning The results provide no support for the routine use of renin-angiotensin system inhibitors for the possible prevention of postoperative atrial fibrillation and adverse events in patients undergoing cardiac surgery.

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“…Although approximately half of the patients undergoing heart surgery are on ACE inhibitors, a controversy regarding their preferential use prior to CABG surgery exists [27]. In our present study ACE inhibitors taken prior to heart surgery had no significant effects on the magnitude of bradykinin-induced dilation in obese patents even though significant interactions between obesity and ACE inhibitors were identified.…”

Section: Discussionmentioning

confidence: 45%

Obesity and statins are both independent predictors of enhanced coronary arteriolar dilation in patients undergoing heart surgery

Cassuto

Fehér

Lan

et al. 2013

J Cardiothorac Surg

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BackgroundA paradoxical inverse relationship between body mass index, morbidity and mortality in patients with ischemic heart disease has been noted; but the underlying mechanisms remain unclear. Given that coronary resistance arteries are the primary regulators of myocardial blood flow, we examined the effects of obesity and medication on dilator function in coronary microvessels.MethodsBradykinin-induced coronary dilation was assessed by videomicroscopy in ex vivo coronary arterioles obtained from 64 consecutive patients undergoing heart surgery. Multi-variable linear regression and logistic regression were used to investigate the effects of obesity (BMI ≥ 30 kg/M2) and the influences of medications on vessel responses.ResultsIn isolated, pressurized (80 mmHg) coronary arterioles of obese and non-obese patient the active (73±4 vs. 79±13 μm) and passive (111 ± 5.5 vs. 118 ± 5.0 μm) diameters were similar. Bradykinin elicited substantial dilation in coronary arterioles, with a similar magnitude in obese and non-obese patients (to 10-8 M: 55 ± 5% vs. 46 ± 5%, P = 0.20), but with significantly enhanced sensitivity in obesity (EC50: 8.2x10-9 M vs. 1.9x10-8 M, respectively, P = 0.03). When adjusted for other risk factors and medications, obesity and statins were determined to be the only positive predictors of enhanced dilation, as assessed with multiple regression analysis. Moreover, obese patients with or without statin exhibited significantly increased coronary dilation to bradykinin, when compared to non-obese patients without statin therapy.ConclusionsObesity and statin therapy are independently associated with an enhanced dilator function of coronary arterioles in patients undergoing heart surgery, which may offer a potential mechanism for the better cardiovascular outcome described earlier as the obesity paradox.

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Outcomes of Preoperative Angiotensin-Converting Enzyme Inhibitor Therapy in Patients Undergoing Isolated Coronary Artery Bypass Grafting

Cited by 36 publications

References 26 publications

Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery

Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery

Association of Preoperative Renin-Angiotensin System Inhibitors With Prevention of Postoperative Atrial Fibrillation and Adverse Events

Obesity and statins are both independent predictors of enhanced coronary arteriolar dilation in patients undergoing heart surgery

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