ACE Inhibitors May Negatively Impact CABG Outcomes

Study finds increased risk of mortality, inotropic support, renal dysfunction and atrial fibrillation
By Eric Metcalf
HealthDay Reporter

THURSDAY, Oct. 29 (HealthDay News) -- The preoperative use of angiotensin-converting enzyme (ACE) inhibitor therapy before coronary artery bypass grafting (CABG) may increase risk of mortality and other adverse outcomes, according to research published in the Nov. 3 Journal of the American College of Cardiology.

Antonio Miceli, M.D., of the University of Bristol in the United Kingdom, and colleagues retrospectively analyzed data from 3,052 patients who underwent isolated CAGB over a 12-year period who received an ACE inhibitor within 24 hours before the procedure, and were matched with an equal number of controls.

The researchers found that ACE inhibitor therapy was associated with an increased risk of mortality within 30 days of the operation as compared to matched controls (1.3 versus 0.7 percent). Preoperative ACE inhibitor administration was also associated with a higher risk of postoperative renal dysfunction (7.1 versus 5.4 percent), atrial fibrillation (25 versus 20 percent), and greater use of inotropic support (45.9 versus 41.1 percent) as compared to matched controls.

"While we await prospective randomized data from patients who most resemble those we routinely treat, the study by Miceli et al should provide pause. Even if there is a net benefit over the long term, there may be short-term risk associated with some pharmacotherapies. Being dogmatic in our use of these agents should be balanced by a modicum of caution and a willingness to keep our eyes open for possible short-term (and avoidable) risks that they may pose," writes the author of an accompanying editorial.

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