Effect of preoperative angiotensin-converting enzyme inhibitor on the outcome of coronary artery bypass graft surgery

The safety of the preoperative administration of angiotensin-converting enzyme inhibitors (ACEIs) in patients undergoing coronary artery bypass grafting (CABG) surgery is still uncertain. This systematic review thus evaluated the effect of preoperative ACEIs on the clinical outcomes in patients undergoing CABG surgery. We searched PubMed, the Cochrane Library and the Web of Science for randomized control trials or observational studies that compared the use of ACEIs with that of placebos before isolated CABG. Thirteen studies (3 randomized control trials and 10 observational studies) that included 31 390 patients met the eligibility criteria. Preoperative ACEI treatment increased the risk of hypotension [risk ratio (RR) = 2.36, 95% confidence interval (CI) 1.11-5.02, P = 0.03], postoperative myocardial infarction (RR = 1.14, 95% CI 1.02-1.27, P = 0.02) and postoperative renal dysfunction (RR = 1.26, 95% CI 1.00-1.60, P = 0.05) in patients undergoing on-pump CABG, but had no significant impact on the risk of postoperative atrial fibrillation (RR = 0.79, 95% CI 0.37-1.71, P = 0.56) or postoperative stroke (RR = 1.17, 95% CI 0.74-1.85, P = 0.50), and did not influence the early mortality (RR = 1.21, 95% CI 0.95-1.54, P = 0.12) in patients undergoing on-pump CABG. Preoperative use of ACEIs increased the risk of several postoperative complications in patients undergoing CABG. Further randomized studies are needed to more clearly elucidate the risks and benefits of ACEI therapy before CABG.