The effect of angiotensin-converting enzyme inhibitor exposure on coronary artery bypass grafting.

Abstract

This study evaluated the impact of preoperative angiotensin-converting enzyme inhibitor (ACEi) exposure on outcomes of coronary artery bypass grafting (CABG). Isolated CABGs from January 2010 to January 2018 at a single institution were included. Primary stratification was based on exposure to an ACEi within 48-hours of CABG. Propensity-matching with a 1:1 ratio was performed to generate cohorts with comparable baseline characteristics. Primary outcomes included operative mortality and morbidity rates as well as prolonged intensive care unit (ICU) stay. Secondary outcomes included hospital readmission. Five-thousand two hundred seventy propensity-matched patients underwent isolated CABG. Baseline characteristics were comparable between those exposed and unexposed to ACEi, with a Society of Thoracic Surgeons predicted risk of mortality of 2.4% in each group (P = .98). Rates of postoperative renal failure (5.0% vs 8.2%; P = .002), new-onset dialysis (1.2% vs 2.2%; P = .004), and prolonged ventilation (7.0% vs 13.4%; P < .0001) were higher in patients without ACEi exposure. The rates of prolonged ICU stay were similar (25.8% vs 27.7%; P = .127). ACEi exposed patients had lower unadjusted (1.7% vs 2.8%; P = .009) and risk-adjusted hazards for mortality at 30-days (hazard ratio, 0.59; 95% confidence interval, 0.40, 0.88; P = .01). Overall readmission rates were similar. Similar findings persisted when limiting the analysis to CABGs performed with the use of cardiopulmonary bypass. This study of 5270 propensity-matched patients suggests that ACEi can safely be continued until the time of CABG without an adverse impact on clinical outcomes, and in fact, may confer an early survival advantage and reduced postoperative renal failure rates.