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Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers After Coronary Artery Bypass
Arden R Barry1,2, Hamed Helisaz3,4, Abdollah Safari3,5
1Faculty of Pharmaceutical Sciences The University of British Columbia Vancouver British Columbia Canada.
Insights
Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) reduced major adverse cardiovascular events (MACE) in patients after coronary artery bypass graft surgery. This benefit was observed regardless of heart failure status, indicating broad cardiovascular protection.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Health Services Research
Background:
- The impact of ACEI/ARBs on MACE post-coronary artery bypass graft (CABG) surgery remains unclear.
- This study investigates ACEI/ARB use and MACE in a large Canadian population undergoing CABG.
Purpose of the Study:
- To evaluate the association between ACEI/ARB exposure and MACE in patients following CABG surgery.
- To determine if heart failure (HF) status modifies the effect of ACEI/ARBs on MACE.
Main Methods:
- Retrospective, population-based cohort study using linked administrative health data.
- Included 15,439 adult patients undergoing CABG between 2002-2020.
- Primary outcome: time to MACE (all-cause death, MI, ischemic stroke) analyzed with Cox models and inverse probability treatment weighting.
Main Results:
- 40% of patients received ACEI/ARBs; 16% had pre-existing heart failure.
- ACEI/ARB exposure was associated with significantly lower MACE risk at 1 and 5 years post-CABG.
- The protective effect was evident in both patients with and without heart failure (interaction P <0.0001).
Conclusions:
- ACEI/ARBs are associated with reduced MACE in patients post-CABG.
- This benefit is consistent across patients with and without heart failure.
- Findings support the use of ACEI/ARBs in CABG patients for cardiovascular risk reduction.
Background:
The effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) on major adverse cardiovascular events (MACE) in patients who undergo coronary artery bypass graft surgery is equivocal. This retrospective, population-based cohort study evaluated effect of exposure to an ACEI/ARB on MACE using linked administrative databases that included all cardiac revascularization procedures, hospitalizations, and prescriptions for the population of British Columbia, Canada.
Methods And Results:
All adults who underwent coronary artery bypass graft surgery between 2002 and 2020 were eligible. The primary outcome was time to MACE, defined as a composite of all-cause death, myocardial infarction, and ischemic stroke using Cox proportional hazards models with inverse probability treatment weighting. Included were 15 439 patients and 6191 (40%) were prescribed an ACEI/ARB. Mean age was 66 years, 83% were men, and 16% had heart failure (HF). Median exposure time was 40 months. Over the 5-year follow-up, 1623 MACE occurred. Impact of exposure was different for patients with and without HF (P <0.0001 for interaction). After probability-weighting and adjustment for relevant covariates, exposure to ACEI/ARBs was associated with a lower hazard of MACE in patients with HF at 1 year (hazard ratio, 0.13 [95% CI, 0.09-0.19]) and 5 years (hazard ratio, 0.36 [95% CI, 0.30-0.44]). In patients without HF, ACEI/ARBs had a lower hazard of MACE at 1 year (hazard ratio, 0.35 [95% CI, 0.27-0.46]) and 5 years (hazard ratio, 0.66 [95% CI, 0.58-0.76]).
Conclusions:
In this population-based study, ACEI/ARBs were associated with a lower hazard of MACE in a cohort of patients post-coronary artery bypass graft surgery irrespective of HF status.
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