Document Detail


Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery.
MedLine Citation:
PMID:  22824930     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: 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 prevalence of atrial fibrillation after cardiac surgery.
DESIGN: Randomized double-blind placebo-controlled study.
SETTING: University-affiliated hospitals.
PATIENTS: Four hundred forty-five adult patients in normal sinus rhythm undergoing elective cardiac surgery.
INTERVENTIONS: One week to 4 days prior to surgery, patients were randomized to treatment with placebo, ramipril (2.5 mg the first 3 days followed by 5 mg/day, with the dose reduced to 2.5 mg/day on the first postoperative day only), or spironolactone (25 mg/day).
MEASUREMENTS: The primary endpoint was the occurrence of electrocardiographically confirmed postoperative atrial fibrillation. Secondary endpoints included acute renal failure, hyperkalemia, the prevalence of hypotension, length of hospital stay, stroke, and death.
MAIN RESULTS: The prevalence of atrial fibrillation was 27.2% in the placebo group, 27.8% in the ramipril group, and 25.9% in the spironolactone group (p=.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=.006). Patients in the placebo group tended to be hospitalized longer than those in the ramipril or spironolactone group (6.8±8.2 days vs. 5.7±3.2 days and 5.8±3.4 days, respectively, p=.08 for the comparison of placebo vs. the active treatment groups using log-rank test). Compared with patients in the placebo group, patients in the spironolactone group were extubated sooner after surgery (576.4±761.5 mins vs. 1091.3±3067.3 mins, p=.04).
CONCLUSIONS: 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.
Authors:
Mias Pretorius; Katherine T Murray; Chang Yu; John G Byrne; Frederic T Billings; Michael R Petracek; James P Greelish; Steven J Hoff; Stephen K Ball; Vineet Mishra; Simon C Body; Nancy J Brown
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-24     Completed Date:  2012-11-20     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2805-12     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN, USA. mias.pretorius@vanderbilt.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00141778
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*,  adverse effects
Atrial Fibrillation / epidemiology,  etiology,  prevention & control*
Blood Pressure
Cardiac Surgical Procedures / adverse effects*
Double-Blind Method
Electrocardiography
Female
Hospitals, University
Humans
Male
Middle Aged
Ramipril / administration & dosage*
Receptors, Mineralocorticoid / metabolism*
Renin-Angiotensin System / drug effects
Spironolactone / administration & dosage*
Grant Support
ID/Acronym/Agency:
HL071002/HL/NHLBI NIH HHS; HL077389/HL/NHLBI NIH HHS; HL085740/HL/NHLBI NIH HHS; KL2 RR024977/RR/NCRR NIH HHS; KL2 TR000446/TR/NCATS NIH HHS; R01 HL071002/HL/NHLBI NIH HHS; R01 HL077389/HL/NHLBI NIH HHS; R01 HL085740/HL/NHLBI NIH HHS; R01 HL098601/HL/NHLBI NIH HHS; TL1 RR024978/RR/NCRR NIH HHS; TL1 TR000447/TR/NCATS NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 TR000445/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Receptors, Mineralocorticoid; 52-01-7/Spironolactone; 87333-19-5/Ramipril
Comments/Corrections
Comment In:
Crit Care Med. 2012 Oct;40(10):2908-9   [PMID:  22986659 ]

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