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ACE Inhibitor Use Preoperatively Decreases Postoperative Complications in Patients with Metabolic Syndrome Undergoing Cardiothoracic or Vascular Interventions

Arizona Heart Institute, Phoenix, AZ

PURPOSE: While diabetes and hypertension are major cardiovascular (CV) risk factors, the cluster of risks such as hypertriglyceridemia, low HDL, increased body mass index (BMI), diabetes and hypertension (called Metabolic Syndrome [MS]) appear to confer increased risk for CV events. Little is known on postoperative outcomes in patients with MS undergoing cardiothoracic or vascular interventions (CVT).

METHODS: Data was collected on 312 patients undergoing CVT (surgical or percutaneous) over a 12 month period. Predictions of poor outcomes were evaluated in patients with metabolic syndrome.

RESULTS: Of 312 patients (mean age 68 ± 11, 69% male, 31% female), 54.4% had MS. Baseline HDL was 43 ± 12 mg/dL, triglyceride 174 ± 159 mg/dL, BMI 27 ± 5.7 sq mbsa, systolic blood pressure 141 ± 23 mmMg and fasting blood sugar 117 ± 39 mg. Most common complications were renal dysfunction (20%), blood transfusion requirement (17%), atrial fibrillation (7.4%) and pleuropericardial effusion (12%). Patients with renal dysfunction as a complication had a higher prevalence of MS (31% vs. 19% without MS) (p = .05). Predictors of increased need for blood transfusion include low HDL (p = .007), high triglyceride (p = .013), previous history of myocardial infarction (p = .047), peripheral vascular disease (p = .002) and atrial fibrillation (p = .003). When preoperative use of Angiotensin Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB), beta blocker, aspirin use and statins were added to the model, ACE inhibitor or ARB use was independently predictive of lower postoperative complications in patients with MS (p = .04).

CONCLUSION: 1. Metabolic syndrome patients have a higher risk of renal dysfunction and blood transfusion requirement postoperatively while undergoing CTV. 2. ACE inhibitor or ARB use preoperatively decreases postoperative complications in MS.

CLINICAL IMPLICATIONS: ACE/ARB use preoperatively in patients with MS undergoing CTV reduces postoperative complications thereby having a potential to improve morbidity, mortality and cost of care.

DISCLOSURE: K. Vijayaraghavan, None.