Preoperative Cardiovascular Risk and Postoperative Outcomes by Renin-Angiotensin System Inhibitor Use: A Secondary Analysis of a Randomized Clinical Trial.

This post hoc analysis explores whether preoperative cardiovascular risk stratification affects the outcomes in patients who continue vs discontinue RASi use before major surgery.

这项事后分析探讨了术前心血管风险分层是否会影响在重大手术前继续使用与停用RASi的患者的治疗结果。

Background

To evaluate whether preoperative cardiovascular risk stratification affects the strategy of RASi management before major noncardiac surgery.

评估术前心血管风险分层是否影响主要非心脏手术前的RASi管理策略。

DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc analysis of the multicenter STOP-or-NOT randomized clinical trial, conducted across 40 hospitals in France between January 2018 and April 2023, with follow-up for 28 days postoperatively.

设计、环境和参与者：这是对在2018年1月至2023年4月期间在法国40家医院进行的多中心STOP-or-NOT随机临床试验的事后分析，术后随访28天。

Data analysis was performed from September 2024 to January 2025.

数据分析工作从2024年9月进行到2025年1月。

The participants were patients who had been treated with RASi for at least 3 months and were scheduled for major noncardiac surgery.

参与者是那些至少接受过3个月RASi治疗并且计划进行重大非心脏手术的患者。

intervention

Patients were randomized to either continue RASi until the day of surgery or to discontinue RASi 48 hours prior to surgery.

患者被随机分配，继续使用RASi直到手术当天，或者在手术前48小时停用RASi。

main_outcomes_and_measures

The primary outcome was a composite of all-cause mortality and major postoperative complications.

主要结果是一个包括全因死亡率和主要术后并发症的复合指标。

Secondary outcomes were major adverse cardiovascular events and acute kidney injury.

次要结果是主要不良心血管事件和急性肾损伤。

Cardiovascular risk stratification was assessed with the Revised Cardiac Risk Index (RCRI), American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index, and systolic blood pressure prior to randomization.

心血管风险分层通过修订版心脏风险指数（RCRI）、贝鲁特美国大学（AUB）-HAS2心血管风险指数以及随机化前的收缩压进行评估。

Results

Among the 2222 patients (median [IQR] age, 68 [61-73] years; 771 [35%] female), 1107 were randomized to RASi continuation and 1115 were randomized to RASi discontinuation.

在2222名患者中（中位年龄[四分位数间距]为68[61-73]岁；女性771名[35%]），1107名被随机分配至RASi维持组，1115名被随机分配至RASi停药组。

Using the RCRI, 592 patients were categorized as low risk (0 points), 1095 as intermediate-low risk (1 point), 418 as intermediate-high risk (2 points), and 117 as high risk (≥3 points).

使用RCRI，592名患者被归类为低风险（0分），1095名为中低风险（1分），418名为中高风险（2分），117名为高风险（≥3分）。

Using the AUB-HAS2 Cardiac Risk Index, 1049 patients were categorized as low risk (0 points), 727 as intermediate-low risk (1 point), 333 as intermediate-high risk (2 points), and 113 as high risk (≥3 points).

使用AUB-HAS2心脏风险指数，1049名患者被归类为低风险（0分），727名为中低风险（1分），333名为中高风险（2分），113名为高风险（≥3分）。

A total of 2132 patients were split into 4 quartiles of preoperative systolic blood pressure.

共有2132名患者被分为4个四分位数的术前收缩压。

The risk of postoperative complications and major adverse cardiovascular events varied with RCRI score.

术后并发症和主要不良心血管事件的风险随着RCRI评分的不同而变化。

However, a strategy of RASi continuation vs discontinuation was not associated with a higher risk of postoperative complications.

然而，继续使用RASi与停用相比，并未与更高的术后并发症风险相关。

Conclusions

This study found that preoperative cardiovascular risk did not affect patient outcomes with respect to the strategy of continuing vs discontinuing RASi before major noncardiac surgery, suggesting that the decision to continue or discontinue RASi should not be influenced by a patient's preoperative cardiovascular risk assessment.

本研究发现，术前心血管风险并不影响患者在主要非心脏手术前继续或停用RASi策略的预后，表明继续或停用RASi的决定不应受患者术前心血管风险评估的影响。

trial_registration

ClinicalTrials.gov Identifier: NCT03374449.

ClinicalTrials.gov注册号：NCT03374449。