NEW YORK (Reuters Health) – The use of ACE inhibitors prior to coronary artery bypass grafting (CABG) is associated with an increased risk of death, need for inotropic support, renal dysfunction, and atrial fibrillation, UK researchers report.

According to the report, 1.3% of patients treated with ACE inhibitors within 24 hours prior to CABG died by 30 days compared with 0.7% of patients not receiving these agents.

ACE inhibitors are a well-established treatment for patients with coronary disease, preventing cardiovascular events and reducing mortality rates, Dr. Massimo Caputo and colleagues from Bristol Heart Institute, University of Bristol, note. Their use pre-CABG, by contrast, is controversial.

The results of the IMAGINE study published last year suggested that pre-CABG treatment with ACE inhibitors did not improve clinical outcomes and may have increased adverse events. Other studies, however, have found that ACE inhibitors can be safely used before cardiac surgery; a survey of UK surgeons found that only 39% routinely discontinue these drugs before the operation.

To better understand the safety of pre-CABG ACE inhibitor therapy, the researchers analyzed prospectively collected data from 10,023 consecutive patients who underwent CABG from April 1996 to May 2008. The study focused on comparison of outcomes for 3052 patients treated preoperatively with ACE inhibitors and 3052 matched controls not treated with these drugs.

The researchers report their findings in the August 12th online issue of the Journal of the American College of Cardiology.

Overall, 1% of patients died within 30 days of their operation. As noted, ACE inhibitor users were twice as likely to die as were non-users.

ACE inhibitor use was also associated with increased rates of post-operative renal dysfunction (7.1% vs. 5.4%), atrial fibrillation (25% vs. 20%), and inotropic use (45.9% vs. 41.1%). Multivariate analysis confirmed an independent association with all three outcomes as well as with mortality.

“Omitting ACE inhibitors before surgery and restarting them postoperatively might be a reasonable approach to improve early outcomes while retaining the benefits of their cardioprotective effects after CABG,” the authors conclude.

Reference:
J Am Coll Cardiol 2009;54.