Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial
Background Postoperative clinical outcomes associated with the preoperative continuation or discontinuation of angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) before cardiac surgery remain unclear. Methods and Results In a single‐center, open‐label, randomize...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-10-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009917 |
| _version_ | 1811274982103187456 |
|---|---|
| author | Sean van Diepen Colleen M. Norris Yinggan Zheng Jayan Nagendran Michelle M. Graham Damaris Gaete Ortega Derek R. Townsend Justin A. Ezekowitz Sean M. Bagshaw |
| author_facet | Sean van Diepen Colleen M. Norris Yinggan Zheng Jayan Nagendran Michelle M. Graham Damaris Gaete Ortega Derek R. Townsend Justin A. Ezekowitz Sean M. Bagshaw |
| author_sort | Sean van Diepen |
| collection | DOAJ |
| description | Background Postoperative clinical outcomes associated with the preoperative continuation or discontinuation of angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) before cardiac surgery remain unclear. Methods and Results In a single‐center, open‐label, randomized, registry‐based clinical trial, patients undergoing nonemergent cardiac surgery were assigned to ACEI/ARB continuation or discontinuation 2 days before surgery. Among the 584 patients screened, 261 met study criteria and 126 (48.3%) patients were enrolled. In total,121 patients (96% adherence; 60 to continuation and 61 to ACEI/ARB discontinuation) underwent surgery and completed the study protocol, and follow‐up was 100% complete. Postoperative intravenous vasopressor use (78.3% versus 75.4%, P=0.703), vasodilator use (71.7% versus 80.3%, P=0.265), vasoplegic shock (31.7% versus 27.9%, P=0.648), median duration of vasopressor (10 versus 5 hours, P=0.494), and vasodilator requirements (10 versus 9 hours, P=0.469) were not significantly different between the continuation and discontinuation arms. No differences were observed in the incidence of acute kidney injury (1.7% versus 1.6%, P=0.991), stroke (no events, mortality (1.7% versus 1.6%, P=0.991), median duration of mechanical ventilation (6 versus 6 hours, P=0.680), and median intensive care unit length of stay (43 versus 27 hours, P=0.420) between the treatment arms. Conclusions A randomized study evaluating the routine continuation or discontinuation of ACEIs or ARBs before cardiac surgery was feasible, and treatment assignment was not associated with differences in postoperative physiological or clinical outcomes. These preliminary findings suggest that preoperative ACEI/ARB management strategies did not affect the postoperative course of patients undergoing cardiac surgery. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02096406. |
| first_indexed | 2024-04-12T23:29:59Z |
| format | Article |
| id | doaj.art-fde39044dd55457ca5aed870ba77eb3a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T23:29:59Z |
| publishDate | 2018-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-fde39044dd55457ca5aed870ba77eb3a2022-12-22T03:12:19ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-10-0172010.1161/JAHA.118.009917Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry TrialSean van Diepen0Colleen M. Norris1Yinggan Zheng2Jayan Nagendran3Michelle M. Graham4Damaris Gaete Ortega5Derek R. Townsend6Justin A. Ezekowitz7Sean M. Bagshaw8Department of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta CanadaDepartment of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta CanadaCanadian VIGOUR Center University of Alberta Edmonton Alberta CanadaDivision of Cardiac Surgery University of Alberta Hospital Edmonton Alberta CanadaDivision of Cardiology Department of Medicine University of Alberta Edmonton Alberta CanadaDepartment of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta CanadaDepartment of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta CanadaDivision of Cardiology Department of Medicine University of Alberta Edmonton Alberta CanadaDepartment of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta CanadaBackground Postoperative clinical outcomes associated with the preoperative continuation or discontinuation of angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) before cardiac surgery remain unclear. Methods and Results In a single‐center, open‐label, randomized, registry‐based clinical trial, patients undergoing nonemergent cardiac surgery were assigned to ACEI/ARB continuation or discontinuation 2 days before surgery. Among the 584 patients screened, 261 met study criteria and 126 (48.3%) patients were enrolled. In total,121 patients (96% adherence; 60 to continuation and 61 to ACEI/ARB discontinuation) underwent surgery and completed the study protocol, and follow‐up was 100% complete. Postoperative intravenous vasopressor use (78.3% versus 75.4%, P=0.703), vasodilator use (71.7% versus 80.3%, P=0.265), vasoplegic shock (31.7% versus 27.9%, P=0.648), median duration of vasopressor (10 versus 5 hours, P=0.494), and vasodilator requirements (10 versus 9 hours, P=0.469) were not significantly different between the continuation and discontinuation arms. No differences were observed in the incidence of acute kidney injury (1.7% versus 1.6%, P=0.991), stroke (no events, mortality (1.7% versus 1.6%, P=0.991), median duration of mechanical ventilation (6 versus 6 hours, P=0.680), and median intensive care unit length of stay (43 versus 27 hours, P=0.420) between the treatment arms. Conclusions A randomized study evaluating the routine continuation or discontinuation of ACEIs or ARBs before cardiac surgery was feasible, and treatment assignment was not associated with differences in postoperative physiological or clinical outcomes. These preliminary findings suggest that preoperative ACEI/ARB management strategies did not affect the postoperative course of patients undergoing cardiac surgery. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02096406.https://www.ahajournals.org/doi/10.1161/JAHA.118.009917angiotensin‐converting enzyme inhibitorangiotensin receptor blockercardiac surgeryvasoplegia |
| spellingShingle | Sean van Diepen Colleen M. Norris Yinggan Zheng Jayan Nagendran Michelle M. Graham Damaris Gaete Ortega Derek R. Townsend Justin A. Ezekowitz Sean M. Bagshaw Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angiotensin‐converting enzyme inhibitor angiotensin receptor blocker cardiac surgery vasoplegia |
| title | Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial |
| title_full | Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial |
| title_fullStr | Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial |
| title_full_unstemmed | Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial |
| title_short | Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial |
| title_sort | comparison of angiotensin converting enzyme inhibitor and angiotensin receptor blocker management strategies before cardiac surgery a pilot randomized controlled registry trial |
| topic | angiotensin‐converting enzyme inhibitor angiotensin receptor blocker cardiac surgery vasoplegia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009917 |
| work_keys_str_mv | AT seanvandiepen comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial AT colleenmnorris comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial AT yingganzheng comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial AT jayannagendran comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial AT michellemgraham comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial AT damarisgaeteortega comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial AT derekrtownsend comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial AT justinaezekowitz comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial AT seanmbagshaw comparisonofangiotensinconvertingenzymeinhibitorandangiotensinreceptorblockermanagementstrategiesbeforecardiacsurgeryapilotrandomizedcontrolledregistrytrial |