Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery.
Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery.
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DOI：
10.1097/ccm.0b013e31825b8be2
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发表时间：
2012-10
影响因子：
8.8
通讯作者：
Brown NJ
中科院分区：
文献类型：
--
作者：
Pretorius M;Murray KT;Yu C;Byrne JG;Billings FT 4th;Petracek MR;Greelish JP;Hoff SJ;Ball SK;Mishra V;Body SC;Brown NJ
This study tested the hypothesis that interruption of the renin-angiotensin system with either an angiotensin-converting enzyme inhibitor or a mineralocorticoid receptor antagonist will decrease the incidence of atrial fibrillation after cardiac surgery. Randomized double-blind placebo-controlled study. University affiliated hospitals. Four-hundred and forty-five adult patients in normal sinus rhythm undergoing elective cardiac surgery. One week to four days prior to surgery, patients were randomized to treatment with placebo, ramipril (2.5 mg the first three days followed by 5mg/day, with the dose reduced to 2.5mg/d on the first postoperative day only), or spironolactone (25 mg/day). The primary endpoint was the occurrence of electrocardiographically confirmed postoperative atrial fibrillation. Secondary endpoints included acute renal failure, hyperkalemia, the incidence of hypotension, length of hospital stay, stroke, and death. The incidence of atrial fibrillation was 27.2% in the placebo group, 27.8% in the ramipril group, and 25.9% in the spironolactone group (P=0.95). Patients in the ramipril (0.7%) or spironolactone (0.7%) group were less likely to develop acute renal failure than those randomized to placebo (5.4%, P=0.006). Patients in the placebo group tended to be hospitalized longer than those in the ramipril or spironolactone group (6.8±8.2 days versus 5.7±3.2 and 5.8±3.4 days, respectively, P=0.08 for the comparison of placebo versus the active treatment groups using log-rank test). Compared to patients in the placebo group, patients in the spironolactone group were extubated sooner after surgery (576.4±761.5 minutes versus 1091.3±3067.3 minutes, P=0.04). Neither angiotensin-converting enzyme inhibition nor mineralocorticoid receptor blockade decreased the primary outcome of postoperative atrial fibrillation. Treatment with an angiotensin-converting enzyme inhibitor or mineralocorticoid receptor antagonist was associated with decreased acute renal failure. Spironolactone use was also associated with a shorter duration of mechanical ventilation after surgery.
