Effect of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers After Coronary Artery Bypass Graft Surgery: A Population‐Based Cohort Study

Abstract

Background The effect of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) on major adverse cardiovascular events (MACE) in patients who undergo coronary artery bypass graft surgery is equivocal. This retrospective, population‐based cohort study evaluated effect of exposure to an ACEI/ARB on MACE using linked administrative databases that included all cardiac revascularization procedures, hospitalizations, and prescriptions for the population of British Columbia, Canada. Methods and Results All adults who underwent coronary artery bypass graft surgery between 2002 and 2020 were eligible. The primary outcome was time to MACE, defined as a composite of all‐cause death, myocardial infarction, and ischemic stroke using Cox proportional hazards models with inverse probability treatment weighting. Included were 15 439 patients and 6191 (40%) were prescribed an ACEI/ARB. Mean age was 66 years, 83% were men, and 16% had heart failure (HF). Median exposure time was 40 months. Over the 5‐year follow‐up, 1623 MACE occurred. Impact of exposure was different for patients with and without HF ( P <0.0001 for interaction). After probability‐weighting and adjustment for relevant covariates, exposure to ACEI/ARBs was associated with a lower hazard of MACE in patients with HF at 1 year (hazard ratio, 0.13 [95% CI, 0.09–0.19]) and 5 years (hazard ratio, 0.36 [95% CI, 0.30–0.44]). In patients without HF, ACEI/ARBs had a lower hazard of MACE at 1 year (hazard ratio, 0.35 [95% CI, 0.27–0.46]) and 5 years (hazard ratio, 0.66 [95% CI, 0.58–0.76]). Conclusions In this population‐based study, ACEI/ARBs were associated with a lower hazard of MACE in a cohort of patients post–coronary artery bypass graft surgery irrespective of HF status.