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Assistant Professor of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT; Director, Pharmacoeconomics and Outcomes Studies Group, Divisions of Cardiology and Drug Information, Hartford Hospital, Hartford, CT
School of Pharmacy, University of Connecticut
Director, Heart Rhythm Center, Division of Cardiology, The Henry Low Heart Center, Hartford Hospital
Associate Professor, School of Pharmacy, University of Connecticut; Director, Cardiac Pharmacology Service, Divisions of Cardiology and Drug Information, Hartford Hospital
Reprints: Dr. White, Divisions of Cardiology and Drug Information, Hartford Hospital, 80 Seymour St., CB309, Hartford, CT 06102, fax 860/545-2277, cmwhite{at}harthosp.org
BACKGROUND: A recent meta-analysis demonstrated that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce the incidence of new-onset atrial fibrillation by nearly 50%. However, the ability of ACE inhibitors or ARBs to prevent post-cardiothoracic surgery (CTS) atrial fibrillation, when used postoperatively, has yet to be evaluated.
OBJECTIVE: To evaluate the impact of postoperative ACE inhibitor or ARB use on the incidence of post-CTS atrial fibrillation.
METHODS: We performed a retrospective cohort study of propensity score matched patients who underwent CTS at a single institution from January 2004 through December 2005. Patients who received either an ACE inhibitor or an ARB within 24 hours of surgery were propensity score matched for common predictors of post-CTS atrial fibrillation (age >70 y, preoperative digoxin use, postoperative ß-blocker or amiodarone use, ß-blocker intolerance, valve surgery, male sex, and history of diabetes mellitus, smoking, chronic obstructive pulmonary disease, prior cardiothoracic surgery) in a 1:1 ratio with patients who did not receive an ACE inhibitor or an ARB. Multivariate logistic regression was used to generate adjusted odds ratios to minimize the impact of baseline confounders.
RESULTS: A total of 1469 patients underwent CTS during the study evaluation period. Postoperatively, 188 received an ACE inhibitor or an ARB and were matched to 188 control patients. Mean ± SD age of matched patients was 68.1 ± 11.8 years, 66% were men, 42% underwent valve surgery, and 69% and 35% received postoperative ß-blockade and amiodarone, respectively. Patients who received an ACE inhibitor or an ARB did not experience a significant reduction in post-CTS atrial fibrillation compared with control patients (adjusted OR 0.95; 95% CI 0.57 to 1.56; p = 0.83).
CONCLUSIONS: In this evaluation, postoperative ACE inhibitor or ARB use was not associated with a reduction in post-CTS atrial fibrillation. A study of preoperative, longer-term ACE inhibitor and/or ARB therapy is needed to determine the benefits of that strategy.
Key Words: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, atrial fibrillation
Published Online, March 6, 2007. www.theannals.com, DOI 10.1345/aph.1H583
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