How to Reduce All-Cause Death, MI, and Stroke by 87% in Post-CABG Patients? Just Use an ACEi!
Thierry MONOD, MD
CMVD World Operations Portfolio Project Director & Operational Director SW Europe and FOCIT
A Canadian 18-year retrospective trial evaluated the combined endpoint of all-cause death, myocardial infarction (MI), and stroke (MACE) in 15,000 patients, comparing those treated with ACEi/ARB to those without. Ultimately, more than 95% of the?treated group received an ACEi (mainly ramipril, perindopril, or captopril), making the results predominantly reflective of ACEi use.
Using a time-to-first-event analysis, the study showed significant outcomes at one year for post-CABG patients without a history of heart failure (HF). These patients experienced a 65% reduction in MACE, with a hazard ratio (HR) of 0.35 (0.27–0.46). At five years, there was a 34% reduction in MACE, with an HR of 0.66 (0.09–0.19), in those treated with an ACEi compared to those without.
Similarly, for post-CABG patients with a history of HF, the study showed a significant 87% reduction in MACE at one year, with an HR of 0.13 (0.09–0.19), and a 64% reduction in MACE at five years, with an HR of 0.36 (0.30–0.44), in those treated with an ACEi compared to those without.
The results of this study strongly support a shift in clinical practice towards more routine prescribing of ACE inhibitors in patients following CABG surgery.
Ref: Effect of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers After Coronary Artery Bypass Graft Surgery: A Population‐Based Cohort Study. Arden R. Barry & al, J Am Heart Assoc 2024 Jun 18;13(12)