impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on mortality of coronary artery bypass grafting

background: there is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors (aceis) or angiotensin receptor blockers (arbs) as regards the postoperative mortality of coronary artery bypass grafting (cabg). this study investigates the correlation between the in-hospital mortality of cabg and the preoperative administration of acei/arb. methods: out of 10055 consecutive patients with isolated cabg from 2006 to 2009, 4664 (46.38%) patients received preoperative acei/arb. data were gathered from the cardiac surgery registry of tehran heart center. in-hospital mortality was defined as death within the same admission for surgery. adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative acei/arb therapy on in-hospital death. results: the mean age of the patients was 60.04 ± 9.51 years and 7364 (73.23%) were male. eighty-seven (0.86%) patients expired within 30 days. multivariate analysis revealed that the administration of acei/arb significantly protected against in-hospital deaths inasmuch as there were 33 (0.70%) vs. 54 (1.0%) deaths in the acei/arb positive and negative groups, respectively (or: 0.628; p value = 0.09). patients without acei/arb were more likely to have a higher global ejection fraction. conclusion: preoperative acei usage in patients undergoing cabg can be associated with decreased in-hospital mortality. large-scale randomized clinical trials are suggested.