THE EFFECTS OF PREOPERATIVE THERAPY WITH ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS ON CLINICAL OUTCOME AFTER CARDIOVASCULAR-SURGERY

Objective: To determine the effect of preoperative therapy with angiot ensin-converting enzyme (ACE) inhibitors on clinical outcome after car diovascular surgery. Study: Inception cohort. Setting: A tertiary care 54-bed cardiothoracic ICU. Patients: All admissions to an ICU over a 42-month period after cardiovascular surgery. Intervention: Extraction of preoperative, operative, and ICU data from a database. Outcome mea sures: Incidence of acute organ dysfunction, length of mechanical vent ilation, ICU stay, and death after cardiovascular surgery. Results: Th e study cohort consisted of four groups: normal or moderately impaired left ventricular function control (group A, n=6,400); normal or moder ately impaired left ventricular function treated with ACE inhibitors ( group B, n=1,375); severe left ventricular dysfunction control (group C, n=1,905); and severe left ventricular dysfunction treated with ACE inhibitors (group D, n=1,650). The incidence of three or more organ dy sfunction was similar on comparison of group A vs group B (5% vs 6%) o r group C vs group D (15% vs 13%). There were no differences in the to tal duration of mechanical ventilation or length of stay in the ICU in group A vs group B or group C vs group D. Death occurred in 2% of gro ups A and B, and at 6% in groups C and D. Preoperative severe left ven tricular dysfunction in both groups C and D was associated with an inc reased incidence of three or more organ dysfunction, duration of mecha nical ventilation, length of stay in ICU, and death after surgery. Mul tivariate analysis indicated that therapy with ACE inhibitors did not affect the clinical outcome after cardiovascular surgery. Conclusion: Preoperative therapy with ACE inhibitors did not influence the clinica l outcome after cardiac surgery. It is unlikely that therapy with ACE inhibitors can alter the clinical sequelae of cardiopulmonary bypass a nd cardiac surgical procedures performed in high-risk patients because of underlying severe left ventricular dysfunction.