Association of Preoperative Renin-Angiotensin System Inhibitors With Prevention of Postoperative Atrial Fibrillation and Adverse Events

Chen, Shaojie; Acou, Willem Jan; Kiuchi, Márcio Galindo; Meyer, Christian; Sommer, Philipp; Martinek, Martin; Schratter, Alexandra; Andréa, Bruno Rustum; Ling, Zhiyu; Liu, Shaowen; Yin, Yuehui; Hindricks, Gerhard; Pürerfellner, Helmut; Krucoff, Mitchell W.; Schmidt, Boris; Chun, K.R. Julian

doi:10.1001/jamanetworkopen.2019.4934

Cited by 15 publications

(12 citation statements)

References 44 publications

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“…Our study showed that patients with POAF were elder, had a higher prevalence of CKD, higher CHA2DS2-VASc score, and poorer echocardiographic profile, all of which are compatible with previous studies (23)(24)(25)(26). Also noted, patients in POAF group were less frequently taking ACEI/ARBs and beta-blockers, both medications were proved to be able to prevent the development of POAF (27,28).…”

Section: Discussionsupporting

confidence: 90%

Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

Hsu

Huang

Chuang

et al. 2021

Front. Cardiovasc. Med.

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Background: Postoperative atrial fibrillation (POAF) results in a longer hospital stay and excess mortality. However, whether POAF would increase stroke rate has been debated for years. When and how long should anticoagulation be used to prevent stroke are unknown. In the study, we planned to investigate the clinical demographics and long-term outcomes of POAF after cardiac surgery in a single-center cohort.Methods: The cohort study used a database from National Taiwan University Hospital, a single tertiary medical center in Taiwan, between 2007 and 2017, to identify patients with prior normal sinus rhythm developing POAF after cardiac surgery. Patients without POAF after cardiac surgery were used as controls. Propensity score matching with 1:1 ratio and Cox regression models were employed to estimate the risk of transient ischemic accident (TIA) or ischemic stroke.Results: From 2007 to 2017, a total of 8,374 patients received open-heart surgery, in which 1,585 patients with a history of AF were excluded. The overall incidence of TIA/ischemic stroke was 3.9% in a median 9.2-years of follow-up. After propensity matching, 1,965 matched paired subjects were included for analysis. Postoperative atrial fibrillation was associated with an increased risk of future AF [Hazard ratio (HR) 1.40, 95% confidence interval (95%CI) = 1.09–1.79, p = 0.008] and heart failure (HF) hospitalization (HR 1.58, 95%CI 1.23–2.04, p < 0.001); however, POAF did not significantly correlate with the risk of TIA/ischemic stroke (HR 1.17, 95%CI 0.85–1.60, p = 0.043). Kaplan-Meier analysis showed that POAF was a significant predictor for future AF, HF hospitalization, and overall mortality, but not for TIA/ischemic stroke.Conclusion: In the Asian population, POAF after cardiac surgery increased the risk of future AF, HF, and overall mortality, but was not associated with future TIA/ischemic stroke.

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Section: Discussionsupporting

confidence: 90%

Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

Hsu

Huang

Chuang

et al. 2021

Front. Cardiovasc. Med.

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“…In animal and in vitro studies, the inhibition of the RAAS impairs plaque development and suppress atherosclerosis ( 31 ). Additionally, ASi may also reduce the risk of rhythm disturbances e.g., atrial fibrillation ( 32 ). Moreover, the prophylactic use of ASi as a prevention of CV complications showed promise in several cancer types e.g., before anthracycline treatment for breast cancer ( 33 ), among lymphoma ( 34 ), kidney ( 35 ), or pancreatic cancer patients ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Angiotensin System Inhibitors May Improve Outcomes of Patients With Castration-Resistant Prostate Cancer During Abiraterone Acetate Treatment—A Cardio-Oncology Study

Wilk¹,

Waśko-Grabowska²,

Skoneczna

et al. 2021

Front. Oncol.

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BackgroundAbiraterone acetate (ABI) therapy improves overall survival in metastatic prostate cancer (PC) patients; however, this effect may be diminished by concurrent comorbidities. We aimed to evaluate the influence of pre-existing chronic diseases and concomitant medications on the course of ABI treatment among post-chemotherapy patients with metastatic castration-resistant prostate cancer patients (mCRPC).MethodsFrom the Polish National Health Fund database, we identified 93 post-chemotherapy, mCRPC patients, who were qualified for ABI treatment in our oncology center between 2014 and 2018. Survival curves and Cox proportional hazard models (univariate and multivariate) were used to determine the predictors for longer time to treatment failure (TTF) of ABI therapy.ResultsMedian TTF was 9,8 months (IQR: 0,6–56,5) Factors associated with longer TTF were: well controlled hypertension (HR, 0.59; 95% CI. 0.38–0.90; p = 0.02), stable coronary artery disease (HR, 0.56; 95% CI, 0.33–0.95; p=0.03), the use of angiotensin system inhibitor (ASi) (HR, 0.61; 95% CI 0.4–0.94; p = 0,02). Patients who were receiving ASi had median TTF of 12.2 months versus 5.8 months in men who did not receive ASi before ABI initiation. At the start of ABI therapy, the aforementioned groups did not differ in terms of well-known prognostic factors: Gleason score, PSA level, or the number of patients with visceral metastases. In a multivariate analysis, the use of ASi remained statistically significant, even after adjustment for well-known oncological factors (HR, 0.57; 95% CI, 0.34–0.98; p = 0.04).ConclusionsThe use of ASi may enhance and prolong ABI therapy in post-docetaxel mCRPC patients and may potentially be considered a new, non-oncological, predictive factor for longer TTF. This association requires a prospective validation.

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“…790 Perioperative steroid use, renin-angiotensin system inhibitors, digoxin prophylaxis, calcium antagonist prophylaxis, n-3 polyunsaturated fatty acids, glucose-insulinpotassium therapy, vasopressin, and NSAIDs have been shown to lack promise. 771,[791][792][793][794][795][796] Intraoperative injection of botulinum toxin into epicardial neural ganglia has been shown to be promising in small RCTs with a larger study in progress. 797…”

Section: Other Potential Therapiesmentioning

confidence: 99%

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Andrade

Aguilar

Atzema

et al. 2020

Canadian Journal of Cardiology

426

496

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The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published R ESUM ELe programme de lignes directrices de la Soci et e canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a et e elabor e pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les d ecideurs politiques et les systèmes de soins de sant e sur des questions connexes. La dernière edition

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Association of Preoperative Renin-Angiotensin System Inhibitors With Prevention of Postoperative Atrial Fibrillation and Adverse Events

Cited by 15 publications

References 44 publications

Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

Angiotensin System Inhibitors May Improve Outcomes of Patients With Castration-Resistant Prostate Cancer During Abiraterone Acetate Treatment—A Cardio-Oncology Study

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

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