Abstract
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.
Highlights
Male Age Diabetes Hypertension Dyslipidemia Chronic kidney disease Stroke Chronic obstructive pulmonary disease Peripheral artery disease LMD 3VD Ejection fraction
After excluding patients without a prescription of renin-angiotensin-aldosterone system (RAAS) inhibitors (N = 4,158) or with concomitant prescription of RAAS inhibitors (N = 23), a total of 1,198 patients were left for analysis and were classified into the two groups (ACEi group [N = 900, 75.2%] and angiotensin receptor blockers (ARBs) group [N = 298, 24.8%])
The main findings of the present study were as follows: (1) postoperative use of ARB after CABG showed a comparable clinical effect to angiotensin converting enzyme inhibitors (ACEi) during median follow-up period of 48 months; (2) the use of ARBs resulted in a significant reduction in adverse events in terms of major adverse cardiovascular and cerebrovascular events (MACCE) during 12 months of follow-up; (3) ARBs showed improved clinical outcomes limited to female patients
Summary
We aimed to compare the clinical effects of the two types of renin-angiotensin-aldosterone system (RAAS) inhibitors in patients who underwent CABG. We aimed to compare the effects of RAAS inhibitors by comparing clinical outcomes after CABG in patients prescribed postoperative ACEi or ARB therapy
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