The effects of preoperative renin-angiotensin system inhibitors on outcomes in patients undergoing cardiac surgery

Pengcai Shi, Zhongmin Li, J Nilas Young, Fuhai Ji, Yuelan Wang, Peter G Moore, Hong Liu

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: The effects of preoperative (pre-op) renin-angiotensin system (RAS) inhibitors on outcomes in patients undergoing cardiac surgery remain uncertain. The aim of this study was to evaluate whether the use of pre-op RAS inhibitors affected major outcomes of cardiac surgery. Design: A retrospective cohort study. Setting: A university teaching hospital. Participants: Patients undergoing cardiac surgery between January 1, 2001 and December 31, 2011. Interventions: One thousand two hundred thirty-nine patients who received pre-op RAS inhibitors were compared with those who did not (control group, n = 1,083). Measurements and Main Results: Acute kidney injury (AKI) was defined using Acute Kidney Injury Network classification. Patients in the RAS inhibitors group presented with higher comorbidities. Pre-op RAS inhibitors therapy was associated with the reduction in the incidence of AKI (27.2% v 34.0%, p<0.001), septicemia (1.9% v 3.5%, p = 0.019), and operative mortality (2.99% v 4.62%, p = 0.039). After adjusted propensity scores and multivariate logistic regression, the pre-op RAS inhibitors were found to have protective effects against AKI (odds ratio [OR]: 0.764, 95% confidence interval [CI]: 0.670-0.873, p<0.001), septicemia (OR: 0.515, 95% CI: 0.348-0.761, p>0.001), and operative mortality (OR: 0.539, 95% CI: 0.348-0.758, p<0.001). Conclusion: The results suggested that pre-op RAS inhibitor therapy was associated with significant reductions in the risk of AKI, operative mortality, and septicemia.

Original languageEnglish (US)
Pages (from-to)703-709
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume27
Issue number4
DOIs
StatePublished - Aug 2013

Fingerprint

Renin-Angiotensin System
Thoracic Surgery
Acute Kidney Injury
Mortality
Risk Reduction Behavior
Teaching Hospitals
Comorbidity
Sepsis
Cohort Studies
Retrospective Studies
Control Groups
Incidence
Therapeutics

Keywords

  • acute kidney injury
  • cardiac surgery
  • renin-angiotensin system inhibitors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

The effects of preoperative renin-angiotensin system inhibitors on outcomes in patients undergoing cardiac surgery. / Shi, Pengcai; Li, Zhongmin; Young, J Nilas; Ji, Fuhai; Wang, Yuelan; Moore, Peter G; Liu, Hong.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 27, No. 4, 08.2013, p. 703-709.

Research output: Contribution to journalArticle

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abstract = "Objective: The effects of preoperative (pre-op) renin-angiotensin system (RAS) inhibitors on outcomes in patients undergoing cardiac surgery remain uncertain. The aim of this study was to evaluate whether the use of pre-op RAS inhibitors affected major outcomes of cardiac surgery. Design: A retrospective cohort study. Setting: A university teaching hospital. Participants: Patients undergoing cardiac surgery between January 1, 2001 and December 31, 2011. Interventions: One thousand two hundred thirty-nine patients who received pre-op RAS inhibitors were compared with those who did not (control group, n = 1,083). Measurements and Main Results: Acute kidney injury (AKI) was defined using Acute Kidney Injury Network classification. Patients in the RAS inhibitors group presented with higher comorbidities. Pre-op RAS inhibitors therapy was associated with the reduction in the incidence of AKI (27.2{\%} v 34.0{\%}, p<0.001), septicemia (1.9{\%} v 3.5{\%}, p = 0.019), and operative mortality (2.99{\%} v 4.62{\%}, p = 0.039). After adjusted propensity scores and multivariate logistic regression, the pre-op RAS inhibitors were found to have protective effects against AKI (odds ratio [OR]: 0.764, 95{\%} confidence interval [CI]: 0.670-0.873, p<0.001), septicemia (OR: 0.515, 95{\%} CI: 0.348-0.761, p>0.001), and operative mortality (OR: 0.539, 95{\%} CI: 0.348-0.758, p<0.001). Conclusion: The results suggested that pre-op RAS inhibitor therapy was associated with significant reductions in the risk of AKI, operative mortality, and septicemia.",
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