Effect of continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on the day of surgery on myocardial injury after non-cardiac surgery: A retrospective cohort study - 07/03/24
Abstract |
Study objective |
To evaluate the effect of continuing of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) prescriptions 24 h before surgery on postoperative myocardial injury and blood pressure in patients undergoing non-cardiac surgery.
Design |
A single-center, retrospective study.
Setting |
Operating room and perioperative care area.
Patients |
42,432 patients who had been taking chronic ACEI/ARB underwent non-cardiac surgery from January 2012 to June 2022.
Interventions |
Patients who discontinued ACEI/ARB 24 h before surgery (withheld group, n=31,055) and those who continued ACEI/ARB 24 h before surgery (continued group, n=11,377).
Measurements |
Primary outcome was myocardial injury after non-cardiac surgery (MINS) within 7 days postoperatively. MINS was defined as an elevated postoperative cardiac troponin measurement above the 99th percentile of the upper reference limit with a rise/fall pattern. Perioperative blood pressure and clinical outcomes were secondary outcomes.
Main results |
Among 42,432 patients, MINS occurred in 2848 patients (6.7%) and was the all-cause of death within 30 days in 122 patients (0.3%). Incidence of MINS was significantly higher in the continued group than the withheld group (847/11,377 [7.4%] vs. 2001/31,055 [6.4%]; OR [95% CI] 1.17 [1.07–1.27]; P<0.001). After 1:1 propensity score matching, 11,373 patients were included in each group. There was still a significant difference for the occurrence of MINS between two groups in matched cohort (7.4% vs. 6.6%, OR [95% CI] 1.14 [1.03–1.26]; P=0.015). Time-average weight of mean arterial pressure <65 mmHg during surgery was significantly higher in the continued group (mean 0.11 vs. 0.09 [95% CI of mean difference] [0.01–0.03]; P<0.001). However, there was no significant difference in other clinical outcomes and mortality.
Conclusions |
Withholding ACEI/ARB before surgery was associated with a reduced risk of intraoperative hypotension and postoperative myocardial injury, but it did not affect overall clinical outcomes in patients undergoing non-cardiac surgery.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Discontinuation of ACEI/ARB on the day of surgery is recommended by guidelines |
• | Taking ACEI/ARB 24 h before surgery was associated with intraoperative hypotension |
• | Postoperative myocardial injury was more common in patients continuing ACEI/ARB |
• | Myocardial infarction, cerebral vascular event and 30 days mortality were not different |
Keywords : Angiotensin-converting enzyme inhibitors, Angiotensin II receptor blockers, Antihypertensive drugs, Hypotension, Myocardial injury
Plan
Vol 94
Article 111401- juin 2024 Retour au numéro
Article précédent
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