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