Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery

作者：Pretorius Mias^*; Murray Katherine T; Yu Chang; Byrne John G; Billings Frederic T; Petracek Michael R; Greelish James P; Hoff Steven J; Ball Stephen K; Mishra Vineet; Body Simon C; Brown Nancy J

来源：Critical Care Medicine, 2012, 40(10): 2805-2812.

DOI：10.1097/CCM.0b013e31825b8be2

• aldosterone
• angiotensin-converting enzyme inhibitors
• atrial fibrillation
• cardiac surgery
• renal insufficiency

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. %26lt;br%26gt;Design: Randomized double-blind placebo-controlled study. %26lt;br%26gt;Setting: University-affiliated hospitals. %26lt;br%26gt;Patients: Four hundred forty-five adult patients in normal sinus rhythm undergoing elective cardiac surgery. %26lt;br%26gt;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). %26lt;br%26gt;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. %26lt;br%26gt;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). %26lt;br%26gt;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. (Crit Care Med 2012; 40:2805-2812)

• 出版日期2012-10