Impact of preoperative renin-angiotensin system inhibitors therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 42, 000 patients

Abstract

Aims: Controversy exists about whether preoperative RASI therapy is associated with adverse postoperative outcomes after cardiac surgery. We performed a meta-analysis to evaluate if preoperative renin-angiotensin system inhibitors (RASI) therapy reduces adverse postoperative outcomes in patients undergoing cardiac surgery. Methods and results: PubMed, EMBASE, Web of Science and Cochrane Library were searched for randomized controlled trials (RCTs) and observational studies (published up to February 2012) assessing the effects of preoperative RASI use on adverse postoperative outcomes compared with no-preoperative RASI use. All statistical analyses were performed with Stata 12.0. Twenty studies with 42, 798 patients were identified. Preoperative RASI therapy was associated with a 22% increased risk of early all-cause mortality (OR 1.22; 95% CI: 1.08-1.38; P=0.002) and a 24% reduced risk of stroke (OR 0.76; 95% CI: 0.60-0.97; P = 0.03) in patients undergoing cardiac surgery compared with control. However, sensitivity analysis by limiting to patients undergoing single coronary artery bypass grafts (CABG) showed that the pooled OR was 0.79 (95% CI: 0.57-1.08, P = 0.14) for incidence of stroke. There is no significant difference in myocardial infarction (OR 1.07; 95% CI: 0.92-1.24; P = 0.37), atrial fibrillation (OR 0.87; 95% CI: 0.71-1.07; P = 0.18) and acute kidney injury (OR 1.06; 95% CI: 0.88-1.28; P = 0.55). Conclusion: Preoperative RASI use significantly increases the risk of early all-cause mortality. It also significantly reduces the incidence of stroke after cardiac surgery, but doesn't in patients undergoing single CABG. No significant difference is observed for myocardial infarction, atrial fibrillation and acute kidney injury.