Drug Therapy Before Coronary Artery Surgery: Nitrates Are Independent Predictors of Mortality and β-Adrenergic Blockers Predict Survival

Weightman, William M.; Gibbs, N. M.; Sheminant, Matthew R.; Whitford, Eric G.; Mahon, Barry; Newman, Mark

doi:10.1097/00132586-199912000-00007

Cited by 24 publications

(40 citation statements)

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“…Indeed, our data showed that pre-operative ACEI therapy increased the risk of death by 2-fold in patients undergoing CABG. The fact that other studies have failed to demonstrated similar results (20,35) is very likely because of inadequate sample size with insufficient power to detect differences in mortality, a very infrequent event after CABG. In addition, it seems that ACEI therapy may increase adverse events during the first 3 months and does not improve clinical outcome up to 3 years after surgery (17).…”

Section: Discussionmentioning

confidence: 96%

Effects of Angiotensin-Converting Enzyme Inhibitor Therapy on Clinical Outcome in Patients Undergoing Coronary Artery Bypass Grafting

Miceli

Capoun

Fino

et al. 2009

Journal of the American College of Cardiology

132

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Section: Discussionmentioning

confidence: 96%

Effects of Angiotensin-Converting Enzyme Inhibitor Therapy on Clinical Outcome in Patients Undergoing Coronary Artery Bypass Grafting

Miceli

Capoun

Fino

et al. 2009

Journal of the American College of Cardiology

132

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“…In contrast, Miceli et al [28] demonstrated that preoperative therapy with ACE inhibitors has increased at twice the risk of death in patients undergoing coronary artery bypass grafting. However, it is believed that other studies [29,30] did not show similar results due to small sample size to detect differences in mortality.…”

Section: Postoperative Afmentioning

confidence: 81%

O uso de inibidores da enzima conversora de angiotensina e sua relação com eventos no pós-operatório de cirurgia de revascularização miocárdica

Radaelli¹,

Bodanese²,

Guaragna³

et al. 2011

Rev Bras Cir Cardiovasc

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O uso de inibidores da enzima conversora de angiotensina e sua relação com eventos no pós-operatório de cirurgia de revascularização miocárdicaThe use of inhibitors of angiotensin-converting enzyme and its relation to events in the postoperative period of CABG Abstract Background: Angiotensin-converting enzyme (ACE) inhibitors reduce the chance of death, myocardial infarction (MI) and cerebrovascular accident (CVA) in patients with coronary disease. However there is no consensus as to its indication in patients undergoing coronary artery bypass grafting (CABG).Objective: To assess the relationship between preoperative use of ACE inhibitors and clinical outcomes after CABG.Methods: Retrospective cohort study. We included data from 3,139 consecutive patients undergoing isolated CABG in Brazilian tertiary care hospital between January 1996 and December 2009. Follow-up was until discharge or death.Clinical outcomes after surgery were analyzed between users and nonusers of ACE inhibitors preoperatively.Results: Fifty-two percent (n=1,635) of patients received ACE inhibitors preoperatively. The use of ACE inhibitors was an independent predictor of need for inotropic support (OR 1.24, 95% CI 1.01 to 1.47, P = 0.01), acute renal failure (OR 1.23, 95% CI 1.01 to 1.73, P = 0.04) and progression to atrial fibrillation (OR 1.32, 95% CI 1.02 to 1.7, P = 0.03) postoperatively. The mortality rate among patients receiving or not preoperative ACE inhibitors was similar (10.3% vs. 9.4%, P = 0.436), as well as the incidence of myocardial infarction and stroke (15.6% vs. 15.0%, P = 0.694 and 3.4% vs. 3.5%, P = 0.963, respectively). Rev Bras Cir Cardiovasc 2011;26(3):373-9

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“…However, in the study of Weber et al, there was no association between preoperative anemia and increased surgical site infection [24]. Other studies found a non-significant relationship, or one with a smaller odds ratios [25,26]. The Kulier et al study showed a significant relationship between preoperative low Hgb and non-cardiac-but not cardiac-complications [1].…”

Section: Discussionmentioning

confidence: 92%

Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery

et al. 2010

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AbstractAnemia is an indisputable finding in patients scheduled for coronary artery bypass graft (CABG) that can occur any time preoperatively. In presence of severe coronary artery disease, anemia can dramatically affect surgical outcomes. Therefore, we conducted this study to determine the effect of low preoperative hemoglobin (Hgb) on postoperative outcome in patients who underwent coronary artery bypass graft (CABG). In all, 4432 patients who had undergone isolated CABG at Tehran Heart Center over the 2-year period from March 2006 to February 2008 were studied. All medical records of the aforementioned patients were derived from our hospital surgery data bank. After adjustment for confounders, the association of different preoperative levels of Hgb with risk of cardiac, pulmonary, infectious, and ischemic complications, and also with prolonged ventilation and resource utilization, were assessed in a multivariable model. After adjustment for confounders that may affect mortality and morbidities, we found that cardiac, infectious, ischemic, and pulmonary complications, as well as postoperative mortality, were significantly higher in anemic patients compared to those with normal Hgb levels. In addition, total ventilation time, total intensive care unit hour stay (ICU), hospital length of stay (HLOS), and postsurgery length of stay (PLOS) were significantly longer in anemic patients. We concluded that isolated CABG patients with preoperative anemia have significantly higher mortality and morbidity, and use more health care resources. Preoperative anemia is an independent variable for increased resource utilization, morbidity, and mortality.

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Drug Therapy Before Coronary Artery Surgery: Nitrates Are Independent Predictors of Mortality and β-Adrenergic Blockers Predict Survival

Cited by 24 publications

References 0 publications

Effects of Angiotensin-Converting Enzyme Inhibitor Therapy on Clinical Outcome in Patients Undergoing Coronary Artery Bypass Grafting

Effects of Angiotensin-Converting Enzyme Inhibitor Therapy on Clinical Outcome in Patients Undergoing Coronary Artery Bypass Grafting

O uso de inibidores da enzima conversora de angiotensina e sua relação com eventos no pós-operatório de cirurgia de revascularização miocárdica

Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery

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