RAS inhibitors help prevent adverse cardiovascular outcomes after CABG
10 Apr 2021
Renin-angiotensin system (RAS) inhibitors appear to protect against major adverse cardiovascular events (MACEs) after coronary artery bypass grafting (CABG), whether or not patients had an indication for treatment, a recent study has shown.
“The results suggest that RAS inhibition is beneficial for all CABG patients. Randomized controlled trials are necessary to confirm this hypothesis,” the researchers said.
Drawing from linked nationwide registries, the researchers assessed 28,782 patients who had undergone first-time isolated CABG between 2006 and 2015. The primary outcome of interest was MACEs, defined as a composite of all-cause mortality, stroke, and myocardial infarction.
Most (n=20,995) included patients had been treated with RAS inhibitors, while the remaining 7,819 were not. Over a median follow-up of 4.9 years, 6,051 patients encountered at least one MACE event, yielding an incidence rate of 21.0 percent. These were mostly deaths (13.1 percent), though strokes and myocardial infarctions occurred in 7.4 percent and 5.2 percent of all patients, respectively.
Fully adjusted Cox regression models showed that RAS medication reduced the risk of MACE in the overall study population by 12 percent (adjusted hazard ratio [aHR], 0.88, 95 percent confidence interval [CI], 0.83–0.93; p<0.0001).
Notably, such a protective effect remained significant even in patients with (aHR, 0.87, 95 percent CI, 0.82–0.93; p<0.0001) and without (aHR, 0.75, 95 percent CI, 0.58–0.98; p=0.034) indications for treatment. RAS inhibitor indication was defined as having left ventricular ejection fraction <50 percent before surgery, or having myocardial infarction as the reason for surgery.