Does preoperative renin-angiotensin inhibitor therapy prevent Afib risk?

  • Chen S & al.
  • JAMA Netw Open
  • 3 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that in patients undergoing cardiac surgery, pre-operative renin-angiotensin system inhibitors (RASIs) treatment was not associated with reduced risk for post-operative atrial fibrillation (POAF), stroke, mortality and hospitalisation.

Why this matters

  • Findings provide no support for the routine use of RASIs for preventing POAF and adverse events in patients undergoing cardiac surgery.

Study design

  • 11 studies involving 27,885 patients (74.4% male; median age, 65 years) met eligibility criteria after a search on PubMed database and the Cochrane Library.
  • Primary outcome: POAF; secondary outcomes: rates of stroke and mortality and duration of hospitalisation.
  • Funding: None disclosed.

Key results

  • Compared with the control group, the use of RASIs was not associated with reduced risk for:
    • POAF (OR, 1.04; 95% CI, 0.91-1.19; I2=72%),
    • stroke (OR, 0.86; 95% CI, 0.62-1.19; P=.37; without significant heterogeneity, P=.11),
    • mortality rate (OR, 1.07; 95% CI, 0.85-1.35; P=.56; without significant heterogeneity, P=.12),
    • adverse cardiac events (OR, 1.04; 95% CI, 0.91-1.18; P=.58), and
    • duration of hospital stay (weighted mean difference, −0.04; 95% CI, −1.05 to 0.98; P=.94).
  • Meta-regression analysis revealed that male sex was significantly associated with POAF (τ2=0.0065; z=3.47; Q=12.047; P<.001 and significantly reduced risk in developing poaf>2=0.018; z=−2.24; Q=5.0091; P=.03).

Limitations

  • Lack of randomised controlled trials in the meta-analysis.
  • Majority of included studies were retrospective in nature.