Preoperative angiotensin-converting enzyme inhibitors protect myocardium from ischemia during coronary artery bypass graft surgery

Benedetto, Umberto; Melina, Giovanni; Capuano, Fabio; Comito, Cosimo; Bianchini, Roberto; Simon, Caterina; Refice, Simone; Angeloni, Emiliano; Sinatra, Riccardo

doi:10.2459/jcm.0b013e32830a6daf

Cited by 34 publications

(13 citation statements)

References 23 publications

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“…The authors concluded that off-pump could be a safe alternative to on-pump CABG without additionally increasing the risk of developing AKI in patients who would benefit from continued RAS inhibitor therapy. 4 This new evidence will encourage cardiac surgeons to use RAS inhibitors in OPCABG patients, but the other remarkable point is that mean arterial pressure was lower and the amount of norepinephrine infusion during operation was larger in patients who received RAS inhibitors than in those did not. Hypotension during positioning of the heart is a matter of concern during OPCABG.…”

Section: Article P 1852mentioning

confidence: 99%

“…1- 4 In the Effects of Quinapril on Vascular Angiotensin-Converting Enzyme and Determinants of Ischemia trial, patients were randomized 4 weeks before CABG to receive either quinapril (40 mg/day) or placebo for 1 year after surgery. 1 Patients treated with quinapril had a 77% reduction in ischemic events (death, revascularization, myocardial infarction, recurrence of angina pectoris, ischemic stroke, or transient ischemic attack stroke; 15% vs 4%; P=0.04).…”

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confidence: 99%

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Role of Renin-Angiotensin System Inhibitors in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Kinoshita

Asai

2010

Circ J

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Section: Article P 1852mentioning

confidence: 99%

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confidence: 99%

Role of Renin-Angiotensin System Inhibitors in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Kinoshita

Asai

2010

Circ J

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“…The pathophysiology of CSA-AKI is multifactorial and results from vascular and tubular injury, ischemia and reperfusion injury, neurohumoral activation, inflammation, (12)(13)(14). The patient was also on a statin before surgery.…”

Section: Differential Diagnosismentioning

confidence: 99%

A Patient with AKI after Cardiac Surgery

Tolwani¹

2014

Clinical Journal of the American Society of Nephrology

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Up to 30% of patients undergoing cardiac surgery develop AKI, with 1% requiring RRT. AKI is an independent risk factor for morbidity and mortality. Postoperatively, even minimal changes in serum creatinine are associated with a substantial increase in mortality. No intervention has been definitely proven effective in reducing kidney injury. The successful prevention and management of AKI involves identifying patients at risk for AKI, recognizing subtle abnormalities in a timely manner, performing basic clinical assessments, and responding appropriately to data obtained. With that in mind, in this Attending Rounds, a woman with AKI in the setting of cardiac surgery is presented to highlight the use of history, physical exam, hemodynamic monitoring, laboratory data trends, and urine indices in establishing the correct diagnosis and appropriate management.

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“…With regard to observational studies, Benedetto et al 50 found in a retrospective study (n¼481) that ACE inhibitors before surgery confer added myocardial protection (reducing cardiac troponin release) in patients undergoing CABG. Further evidence supporting the beneficial effects of the ACE inhibitor ramipril in reducing/preventing cardiovascular events comes from the landmark Heart Outcomes Prevention Evaluation trial, which included 9297 patients with high risk of CVD.…”

Section: )mentioning

confidence: 99%

ACE inhibitors in cardiac surgery: current studies and controversies

2010

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Major complications associated with cardiac surgery are still common and carry great prognostic significance. Current medical interventions to prevent these cardiovascular complications include antiplatelet therapy, statins, b-blockers and angiotensinconverting enzyme (ACE) inhibitors. Both experimental studies and clinical trials have shown that ACE inhibitors hold promise as cardiovascular protective agents for cardiac surgery patients. Several lines of evidence support this hypothesis. First, long-term use of ACE inhibitors has been well established to provide cardiovascular protection and reduce ischemic events and complications, independent of their effect on heart function and blood pressure. Second, early ACE inhibitor therapy has been demonstrated to produce remarkable survival and heart function benefits in patients with acute myocardial infarction. Third, ACE blockage can prevent or delay the development or progression of renal disease at all stages, from subclinical microalbuminuria to end-stage renal disease. Nevertheless, perioperative studies of the effects of ACE inhibitors remain few and inconclusive. Results from recent clinical trials and observational studies are conflicting and raise more questions than answers. Further studies, both retrospective and larger-scale prospective studies, are critically needed to examine whether ACE inhibitors reduce mortality and major complications in patients undergoing cardiac surgery.

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Preoperative angiotensin-converting enzyme inhibitors protect myocardium from ischemia during coronary artery bypass graft surgery

Cited by 34 publications

References 23 publications

Role of Renin-Angiotensin System Inhibitors in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Role of Renin-Angiotensin System Inhibitors in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

A Patient with AKI after Cardiac Surgery

ACE inhibitors in cardiac surgery: current studies and controversies

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