Miceli Antonio, Capoun Radek, Fino Carlo, Narayan Pradeep, Bryan Alan J, Angelini Gianni D, Caputo Massimo
Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
J Am Coll Cardiol. 2009 Nov 3;54(19):1778-84. doi: 10.1016/j.jacc.2009.07.008. Epub 2009 Aug 13.
This study evaluates the effect of pre-operative angiotensin-converting enzyme inhibitor (ACEI) therapy on early clinical outcomes after coronary artery bypass grafting (CABG).
Therapy with ACEIs has been shown to reduce the rate of mortality and prevent cardiovascular events in patients with coronary artery disease. However, their pre-operative use in patients undergoing CABG is still controversial.
A retrospective, observational, cohort study was undertaken of prospectively collected data on 10,023 consecutive patients undergoing isolated CABG between April 1996 and May 2008. Of these, 3,052 patients receiving pre-operative ACEI were matched to a control group by propensity score analysis.
Overall rate of mortality was 1%. Pre-operative ACEI therapy was associated with a doubling in the risk of death (1.3% vs. 0.7%; odds ratio [OR]: 2.00, 95% confidence interval [CI]: 1.17 to 3.42; p = 0.013). There was also a significant difference between the ACEI and control group in the risk of post-operative renal dysfunction (PRD) (7.1% vs. 5.4%; OR: 1.36, 95% CI: 1.1 to 1.67; p = 0.006), atrial fibrillation (AF) (25% vs. 20%; OR: 1.34, 95% CI: 1.18 to 1.51; p < 0.0001), and increased use of inotropic support (45.9% vs. 41.1%; OR: 1.22, 95% CI: 1.1 to 1.36; p < 0.0001). In a multivariate analysis, pre-operative ACEI treatment was an independent predictor of mortality (p = 0.04), PRD (p = 0.0002), use of inotropic drugs (p < 0.0001), and AF (p < 0.0001).
Pre-operative therapy with ACEI is associated with an increased risk of mortality, use of inotropic support, PRD, and new onset of post-operative AF.
本研究评估术前血管紧张素转换酶抑制剂（ACEI）治疗对冠状动脉旁路移植术（CABG）后早期临床结局的影响。
ACEI治疗已被证明可降低冠心病患者的死亡率并预防心血管事件。然而，其在接受CABG手术患者中的术前使用仍存在争议。
对1996年4月至2008年5月期间连续接受单纯CABG手术的10023例患者的前瞻性收集数据进行回顾性观察队列研究。其中，通过倾向评分分析将3052例接受术前ACEI治疗的患者与一个对照组进行匹配。
总体死亡率为1%。术前ACEI治疗与死亡风险加倍相关（1.3%对0.7%；优势比[OR]：2.00，95%置信区间[CI]：1.17至3.42；p = 0.013）。ACEI组与对照组在术后肾功能不全（PRD）风险（7.1%对5.4%；OR：1.36，95% CI：1.1至1.67；p = 0.006）、心房颤动（AF）（25%对20%；OR：1.34，95% CI：1.18至1.51；p < 0.0001）以及增加使用正性肌力支持（45.9%对41.1%；OR：1.22，95% CI：1.1至1.36；p < 0.0001）方面也存在显著差异。在多变量分析中，术前ACEI治疗是死亡率（p = 0.04）、PRD（p = 0.0002）、使用正性肌力药物（p < 0.0001）和AF（p < 0.0001）的独立预测因素。
术前ACEI治疗与死亡率增加、使用正性肌力支持、PRD以及术后新发AF风险增加相关。
