Effects of angiotensin-converting enzyme inhibitor therapy on clinical outcome in XXXX undergoing coronary artery bypass grafting.

@entity1 @entity8 @entity955 @entity453 @entity204 @entity65
OBJECTIVES: This study evaluates the effect of pre-operative angiotensin-converting enzyme inhibitor (ACEI) therapy on early clinical outcomes after coronary artery bypass grafting (CABG). BACKGROUND: Therapy with ACEIs has been shown to reduce the rate of mortality and prevent @entity65 in @entity1 with @entity453 . However, their pre-operative use in @entity1 undergoing CABG is still controversial. METHODS: A retrospective, observational, cohort study was undertaken of prospectively collected data on 10,023 consecutive @entity1 undergoing isolated CABG between April 1996 and May 2008. Of these, 3,052 @entity1 receiving pre-operative ACEI were matched to a control group by propensity score analysis. RESULTS: Overall rate of mortality was 1%. Pre-operative ACEI therapy was associated with a doubling in the risk of @entity204 (1.3% vs. 0.7%; odds ratio [OR]: 2.00, 95% confidence interval [CI]: 1.17 to 3.42; p = 0.013). There was also a significant difference between the ACEI and control group in the risk of @entity8 ( @entity8 ) (7.1% vs. 5.4%; OR: 1.36, 95% CI: 1.1 to 1.67; p = 0.006), @entity955 ( @entity955 ) (25% vs. 20%; OR: 1.34, 95% CI: 1.18 to 1.51; p < 0.0001), and increased use of inotropic support (45.9% vs. 41.1%; OR: 1.22, 95% CI: 1.1 to 1.36; p < 0.0001). In a multivariate analysis, pre-operative ACEI treatment was an independent predictor of mortality (p = 0.04), @entity8 (p = 0.0002), use of inotropic drugs (p < 0.0001), and @entity955 (p < 0.0001). CONCLUSIONS: Pre-operative therapy with ACEI is associated with an increased risk of mortality, use of inotropic support, @entity8 , and new onset of post-operative @entity955 .
