Preoperative Cardiovascular Risk and Postoperative Outcomes by Renin-Angiotensin System Inhibitor Use: A Secondary...

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Renin-angiotensin system inhibitors (RASi) are commonly used medications.
• Management of RASi before major noncardiac surgery is debated.
• The STOP-or-NOT trial found no difference in outcomes between continuing or discontinuing RASi.

Purpose of the Study:

• To determine if preoperative cardiovascular risk stratification influences outcomes in patients undergoing major noncardiac surgery.
• To analyze the impact of continuing versus discontinuing RASi based on patient risk profiles.

Main Methods:

• Post hoc analysis of the STOP-or-NOT randomized clinical trial.
• Inclusion of patients on RASi for at least 3 months scheduled for major noncardiac surgery.
• Randomization to continue RASi or discontinue 48 hours prior to surgery.
• Assessment of cardiovascular risk using RCRI, AUB-HAS2 index, and systolic blood pressure.

Main Results:

• No significant difference in postoperative death or major complications between RASi continuation and discontinuation groups.
• Cardiovascular risk stratification (RCRI, AUB-HAS2) showed varied risks for complications and MACE.
• The strategy of RASi management was not influenced by preoperative cardiovascular risk stratification.
• No increased risk of postoperative complications with RASi continuation versus discontinuation.

Conclusions:

• Preoperative cardiovascular risk assessment does not appear to influence patient outcomes regarding RASi management before major noncardiac surgery.
• The decision to continue or discontinue RASi should not be based on preoperative cardiovascular risk stratification.
• Current findings support the STOP-or-NOT trial's conclusion that RASi management strategy is independent of preoperative risk assessment.