Outcomes of Angiotensin Converting Enzyme Inhibitor Management Strategies Prior to Coronary Artery Bypass
Status:
Completed
Trial end date:
2018-03-01
Target enrollment:
Participant gender:
Summary
Coronary artery disease is a leading cause of death, hospitalization, and health care costs
in developed nations. Coronary revascularization with coronary artery bypass graft (CABG)
surgery improves the long term survival in patients with diabetes and multi-vessel disease.
Angiotensin converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) reduce
mortality and subsequent cardiac events in patients with coronary artery disease undergoing
CABG surgery when initiated at least 4 weeks pre-operatively. Observational data have
suggested that pre-operative ACE administration is associated with an increased risk of
post-operative vasoplegic shock, acute kidney injury, and mortality; however, other studies
have failed to confirm these findings and further suggested ACE are associated with a reduced
risk of peri-operative myocardial infarction. A single trial of 40 CABG patients randomized
to pre-operative ACE withdrawal or continuation reported that the withdrawal group required
significantly fewer vasopressors during cardiopulmonary bypass but more intravenous
vasodilators post-operatively to control hypertension. Hence, it remains unclear whether ACEs
should be held or continued immediately prior to CABG surgery and a survey of cardiac
surgeons suggests that current clinical practice is divided. This pilot study aims to
establish the feasibility of the study design and to determine the frequency of clinical
endpoints among patients who continue and discontinue ACE prior to cardiac surgery.