The Effects of Preoperative Renin-Angiotensin System Inhibitors on Outcomes in Patients Undergoing Cardiac Surgery

Shi, Pengcai; Li, Zhongmin; Young, Justin R.; Ji, Fuhai; Wang, Yuelan; Moore, P. G.; Li, Hong

doi:10.1053/j.jvca.2013.01.012

Cited by 16 publications

(9 citation statements)

References 33 publications

(16 reference statements)

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“…AKI was defined as an increase in serum creatinine of ≥0.3 mg/dL or a 50% increase in creatinine when pre‐ and postoperative values were compared . A number of other investigators have identified AKI associated with AAB use in patients undergoing cardiac, vascular, and lung surgery. Similarly, in the present study, in orthopedic patients, AAB remained a significant risk factor for developing AKI (OR: 2.68, P = 0.034) independent of patient comorbidities and adjunct therapy (Table ).…”

Section: Discussionmentioning

confidence: 99%

“…Debate continues as to whether this hypotension results in any significant clinical sequelae. Some authors found that the use of an ACEI decreased the incidence of acute kidney injury (AKI), mortality, and septicemia in cardiac and vascular surgical patients . However, others found that in vascular and cardiac surgery there is increased mortality as well as increased incidence of postoperative AKI .…”

mentioning

confidence: 99%

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Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

Nielson

Hennrikus

Lehman

et al. 2014

Journal of Hospital Medicine

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BACKGROUND:Patients presenting for surgery with angiotensin axis blockade (AAB) from therapy with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers experience an increased incidence of perioperative hypotension. Acute kidney injury (AKI) in patients receiving preoperative AAB has been demonstrated after lung, vascular, and cardiac surgery. However, there is little literature evaluating the hypotensive and renal effects of preoperative AAB and major orthopedic surgery.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

Nielson

Hennrikus

Lehman

et al. 2014

Journal of Hospital Medicine

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“…Third, the results are mechanistically plausible, as hypotension-induced organ dysfunction and bradykinin-triggered inflammation with vascular permeability seen with angioedema might have driven the adverse outcomes [20]. If OSCS contaminated heparin was associated with adverse outcomes, mechanisms other than bradykinin production might have been involved as patients in the control group who were taking an angiotensin-converting-enzyme inhibitor (also associated with increased bradykinin [11]) had fewer complications. The protective effect of angiotensin-converting-enzyme inhibitors could be attributable to blocking the increased expression of pro-inflammatory factors triggered by angiotensin II and by reducing the stimulation of superoxide formation [21], [22].…”

Section: Discussionmentioning

confidence: 96%

“…As secondary outcomes we analyzed Intensive Care Unit length of stay and the lowest recorded platelet count during the first ten postoperative days to compare severity of thrombocytopenia. Except for platelet count these outcomes are defined in the Society of Thoracic Surgery database [11]. A subgroup analysis for patients taking angiotensin-converting-enzyme-inhibitors or angiotensin-receptor-blocker was planned, as the angiotensin-converting-enzyme-inhibitors increase bradykinin concentrations and could therefore modify the effects of OSCS contaminated heparin [12].…”

Section: Methodsmentioning

confidence: 99%

Contaminated Heparin and Outcomes after Cardiac Surgery: A Retrospective Propensity-Matched Cohort Study

et al. 2014

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BackgroundDuring 2007 and 2008 it is likely that millions of patients in the US received heparin contaminated (CH) with oversulfated chondroitin sulfate, which was associated with anaphylactoid reactions. We tested the hypothesis that CH was associated with serious morbidity, mortality, intensive care unit (ICU) stay and heparin-induced thrombocytopenia following adult cardiac surgery.Methods and FindingsWe conducted a single center, retrospective, propensity-matched cohort study during the period of CH and the equivalent time frame in the three preceding or the two following years. Perioperative data were obtained from the institutional record of the Society of Thoracic Surgeons National Database, for which the data collection is prospective, standardized and performed by independent investigators. After matching, logistic regression was performed to evaluate the independent effect of CH on the composite adverse outcome (myocardial infarction, stroke, pneumonia, dialysis, cardiac arrest) and on mortality. Cox regression was used to determine the association between CH and ICU length of stay. The 1∶5 matched groups included 220 patients potentially exposed to CH and 918 controls. There were more adverse outcomes in the exposed cohort (20.9% versus 12.0%; difference = 8.9%; 95% CI 3.6% to 15.1%, P<0.001) with an odds ratio for CH of 2.0 (95% CI, 1.4 to 3.0, P<0.001). In the exposed group there was a non-significant increase in mortality (5.9% versus 3.5%, difference = 2.4%; 95% CI, −0.4 to 3.5%, P = 0.1), the median ICU stay was longer by 14.1 hours (interquartile range −26.6 to 79.8, S = 3299, P = 0.0004) with an estimated hazard ratio for CH of 1.2 (95% CI, 1.0 to 1.4, P = 0.04). There was no difference in nadir platelet counts between cohorts.ConclusionsThe results from this single center study suggest the possibility that contaminated heparin might have contributed to serious morbidity following cardiac surgery.

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“…It is the first study to show comparable reno-and cardioprotective effects between a renin-angiotensin system (RAS) blocker (telmisartan) and ramipril in a broad section of at-risk patients, on top of standard care (75). In a study with nearly half of the patients received ACE inhibitors were diabetics, preoperative ACE inhibitor therapy was associated with significant reductions in the risk of acute kidney injury (AKI), operative mortality, and septicemia in open-heart surgeries (76). In a retrospective cohort study, we have recently shown that preoperative use of rennin-angiotensin system inhibitors may have significant renoprotective effects for aging patients undergoing elective cardiac surgery (77).…”

Section: Angiotensin-converting Enzyme Inhibitors/renin-angiotensin Smentioning

confidence: 99%

Evidence for Preoperative Aspirin Improving Major Outcomes in Patients With Chronic Kidney Disease Undergoing Cardiac Surgery

Yao¹,

Young²,

Liu³

et al. 2015

Annals of Surgery

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Aim of review:Diabetes is a chronic and slowly progressing disease that has a tendency to develop rapidly deteriorating complications such as major adverse cardiovascular events (MACE), especially under the stress of surgery. While clinical strategy to prevent MACE is controversial and uncertain. Method: We conducted a comprehensive review of current clinical strategies in preventing perioperative MACE, in particularly related to diabetic patients. Results: The major findings are: 1) Current clinical studies have demonstrated that coronary artery bypass graft (CABG) is still a better therapy than percutaneous coronary intervention (PCI) on the ground of reducing repeat revascularization, myocardial infarction and death for most diabetic patients with left main-stem and multivessel coronary artery disease who require revascularization, however, it remains to be studied whether coronary revascularization before noncardiac surgery can protect diabetic patients from MACE; 2) There is lack of evidence that intensive or "tight" glycemic control perioperatively can reduce MACE, instead, a moderate or less stringent glucose management probably is safer for patients undergoing surgery;3) The recent results of clinical trials on beta-blockers appear to be disappointing in preventing MACE in surgical patients, including diabetic patients. Meanwhile, the perioperative therapy with statins, angiotensin-converting enzyme inhibitors or multifactorial interventions is promising in preventing MACE in diabetic patients. Summary: Further studies targeted at preventing MACE in diabetic patients undergoing surgery are needed in order to fight this major health problem in perioperative medicine. ABSTRACT

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The Effects of Preoperative Renin-Angiotensin System Inhibitors on Outcomes in Patients Undergoing Cardiac Surgery

Cited by 16 publications

References 33 publications

Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

Contaminated Heparin and Outcomes after Cardiac Surgery: A Retrospective Propensity-Matched Cohort Study

Evidence for Preoperative Aspirin Improving Major Outcomes in Patients With Chronic Kidney Disease Undergoing Cardiac Surgery

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