Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery

Matthieu Legrand; Jérémy Falcone; Bernard Cholley; Hélène Charbonneau; Amélie Delaporte; Adrien Lemoine; Matthias Garot; Alexandre Joosten; Claude Meistelman; Delphine Cheron-Leroy; Jean-Philippe Rives; Bruno Pastene; Antoine Dewitte; Stéphanie Sigaut; Marc Danguy Des Deserts; Cyrille Truc; Matthieu Boisson; Sigismond Lasocki; Philippe Cuvillon; Ugo Schiff; Samir Jaber; Morgan Le Guen; Anaïs Caillard; Stéphane Bar; Edmundo Pereira de Souza Neto; Vincent Colas; Florin Dimache; Thibaut Girardot; Elsa Jozefowicz; Simon Viquesnel; Francis Berthier; Eric Vicaut; Etienne Gayat; Simon Monziols; Mylene Defaye; Thibault Camus; Jean-Jacques Robin; Alexandre Ouattara; Ioana Fetita; Olivier Joannes-Boyau; Eline Bonnardel; Rémi Bouquerel; Antoine Strzelecki; Thibaut Fayon; Christophe Pelletier; Benjamin Le Gaillard; Géraud Amoussou; Maalik El Bouyousfi; Bruno Ganascia; Calliope Butrulle; Soizic Gergaud; Pierre Habrial; Solène Pessiot; Emmanuel Samson; Caroline Wolff; Nevena Stankova; Farida Aouati; Juliette Kavafyan; Vlad Suparschi; Dan Longrois; Julie Le Roy; Benoit Rossignol; Olivier Huet; Christophe Boisson; Pierre Olivier Bonnin; Mohamed Dhaouadi; Ghislaine Gardes; Mikael Perin; Sophie Brunet; Yann Gricourt; Marc-Olivier Fischer; Stéphane Debroczi; Lucie Retournay; Pierre Strub; Patrice Vivin; Rachel Dupays; Thomas Kerforne; Gabriel Vianet; Virginie Manzano; Eric Noll; Pierre-Olivier Ludes; Thien-Nga Chamaraux-Tran; Cédric Cirenei; Djihad Hamroun; Benoit Lebas; Grégoire Andrieu Andrieu; Vincent Etienne; Raphaël Cinotti; Natacha Simon; Denis Frasca; Hélène Beloeil; Amandine Le Gall; Petyo Techev; Ludovic Meuret; Jérémie Joffre; Hervé Dupont; Beny Charbit; Arthur Davy; David Lobo; Jean-Michel Devys; Benjamin Soria; Clémentine Cholet; Cyrus Motamed; Anne Wyniecki; Valérie Billard; Migena Demiri; Clement Millet; Samuel Degoul; Christophe Canevet; Céline Mounier; Flavie Desrumaux; Julia Martinez; Claire Texier; Benoit Voisin; Guillaume Dubreuil; Jacques de Montblanc; Claire Mengelle; Laura Ruscio; Emmanuel Futier; Julie Fayon; Benoit Baietto; Marie Vignaud; Yoann Munier; Bertille Paquette; Diana Saptefrat; Zakia Machroub; Jean-Sébastien Aubert; Georges Abi Abdallah; Nicolas Polge; Najla Dachraoui; Anne Godier; Diane Zlotnik; Hélène Nougue; Darless Clausse; Sabrina Ma; Sherifatou Salami-Adjavon; Patrick Rossignol; Romain Barthélémy; Damien Logeart; Peggy Reiner; Karine Pautrat; Alex Hong; Marine Coroir; Claire Mayeur; Jacques Thes; Florent Laverdure; Sofiane Seri; Violeta Bercan; Cristian Radu Ionescu; Caroline Gonnet Pinton; Marc Leone; Nathalie Lesavre; Jeanne Chatelon; Marion Poirier; Adrien Rivory; Stéphanie Roullet; Sean Coeckelenbergh; Leila Toubal; Joanna Ramadan; Karine Nouette-Gaulain; Bruno Ralec; Chloé Thill; Christophe Giacardi; Etienne Montelescaut; Philippe Aries; Benoît Tavernier; Julie Bellet; Romain Delassus; Hélène Tribouillard; Daniel Verzilli; Alice Millot; Audrey de Jong; Marie Geniez; Virginie Marre; Michaëla Penne; Yvan Pouzeratte; Guillaume Rao; Maxime Coutrot; Alice Blet; Benoit Plaud; Emmanuel Basto; Mathilde Ponsin; Marie-Christine Becq; Maïté Chaussard; Aristide Ntahe; François Depret; Lucie Guillemet; Arnaud Valent; Lyse Flores; Julien Burey; Sarah Feray; Yoann Elmaleh; Sophie Dupeyrat; Thomas Baury; Clémentine Taconet; Thomas Rimmele; Elodie Mazocky; Marie Luce Parrouffe; Catherine Jadaud; Stanislas Abrard; Pierre-Antoine Tronche; Arthur Vial; Emma Aka; Anne-Sophie Bellocq; Jean-François Carabalona; Blandine Fayard; Jean Marie Guyader; Letitia Huriaux; Ingrid Millot; Antoine Lamblin; Marine Dutour; Mathilde Roukhomovsky-Moretti; Pascal Meuret; Nadir Omrani; Barnabé Raymond; Clemence Roy; Florent Sigwalt; Xavier Merindol; Mathieu Desmard; Louis Bourreau; Pierre-Antoine Allain; Charlotte Dei Svaldi; Brenton Alexander

doi:10.1001/jama.2024.17123

Back

Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery

Journal article

Open access

Peer reviewed

Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery

Matthieu Legrand, Jérémy Falcone, Bernard Cholley, Hélène Charbonneau, Amélie Delaporte, Adrien Lemoine, Matthias Garot, Alexandre Joosten, Claude Meistelman, Delphine Cheron-Leroy, …

JAMA Cardiology, Vol.332(12), pp.970-978

30/08/2024

DOI: https://doi.org/10.1001/jama.2024.17123

PMCID: PMC11365013

PMID: 39212270

Abstract

Aged

Angiotensin Receptor Antagonists* / administration & dosage

Angiotensin-Converting Enzyme Inhibitors* / adverse effects

Female

Hypotension / prevention & control

Hospital Mortality

Humans

Hypotension / epidemiology

Hypotension / etiology

Intraoperative Complications / epidemiology

Intraoperative Complications / etiology

Intraoperative Complications / prevention & control

Postoperative Complications* / etiology

Length of Stay

Male

Middle Aged

Postoperative Complications* / epidemiology

Postoperative Complications* / prevention & control

Angiotensin Receptor Antagonists* / adverse effects

Preoperative Care / methods

Renin-Angiotensin System / drug effects

Surgical Procedures, Operative* / adverse effects

Time Factors

Angiotensin-Converting Enzyme Inhibitors* / administration & dosage

Importance: Before surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines. Objective: To evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery. Design, Setting, and Participants: Randomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France. Intervention: Patients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115). Main Outcomes and Measures: The primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery. Results: Of the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes. Conclusions and Relevance: Among patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy. Trial Registration: ClinicalTrials.gov Identifier: NCT03374449

Files and links (1)

url

Find in HALView

Metrics

1 Record Views

See more details

Details

Title: Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery
Creators - without role: Matthieu Legrand - University of California, San Francisco
Jérémy Falcone - Hôpital Claude Huriez
Bernard Cholley - Assistance Publique – Hôpitaux de Paris
Hélène Charbonneau - Clinique Pasteur
Amélie Delaporte - Hôpital Marie Lannelongue
Adrien Lemoine - Hôpital Tenon
Matthias Garot - Hôpital Claude Huriez
Alexandre Joosten - University of California, Los Angeles
Claude Meistelman - Hôpital Saint Charles
Delphine Cheron-Leroy - Université Paris Cité
Jean-Philippe Rives - Institut Gustave Roussy
Bruno Pastene - Hôpital Nord
Antoine Dewitte - Centre Hospitalier Universitaire de Bordeaux
Stéphanie Sigaut - Hôpital Beaujon
Marc Danguy Des Deserts - Hôpital d'Instruction des Armées Clermont-Tonnerre
Cyrille Truc - Hospices Civils de Lyon
Matthieu Boisson - Université de Poitiers
Sigismond Lasocki - Centre Hospitalier Universitaire d'Angers
Philippe Cuvillon - Centre Hospitalier Universitaire de Nîmes
Ugo Schiff - Centre Hospitalier Universitaire de Clermont-Ferrand
Samir Jaber - Université de Montpellier, Physiologie et Médecine Expérimentale du coeur et des muscles - PhyMedExp
Morgan Le Guen - Hôpital Foch
Anaïs Caillard - Centre Hospitalier Régional Universitaire de Brest
Stéphane Bar - Centre Hospitalier Universitaire Amiens-Picardie
Edmundo Pereira de Souza Neto - Centre hospitalier de Montauban
Vincent Colas - Groupe Hospitalier de l'Institut Catholique de Lille
Florin Dimache - Hôpitaux Universitaires de Strasbourg
Thibaut Girardot - Centre Hospitalier de Valence
Elsa Jozefowicz - Hôpital Roger Salengro
Simon Viquesnel - Centre Hospitalier Universitaire de Rennes
Francis Berthier - Inserm
Eric Vicaut - Université Paris Cité
Etienne Gayat - French Clinical Research Infrastructure Network
Simon Monziols
Mylene Defaye
Thibault Camus
Jean-Jacques Robin
Alexandre Ouattara
Ioana Fetita
Olivier Joannes-Boyau
Eline Bonnardel
Rémi Bouquerel
Antoine Strzelecki
Thibaut Fayon
Christophe Pelletier
Benjamin Le Gaillard
Thibaut Girardot - Centre Hospitalier de Valence
Géraud Amoussou
Maalik El Bouyousfi
Bruno Ganascia
Calliope Butrulle
Soizic Gergaud
Pierre Habrial
Solène Pessiot
Emmanuel Samson
Caroline Wolff
Nevena Stankova
Farida Aouati
Juliette Kavafyan
Vlad Suparschi
Dan Longrois
Julie Le Roy
Benoit Rossignol
Olivier Huet
Christophe Boisson
Pierre Olivier Bonnin
Mohamed Dhaouadi
Ghislaine Gardes
Mikael Perin
Sophie Brunet
Yann Gricourt
Marc-Olivier Fischer
Stéphane Debroczi
Lucie Retournay
Pierre Strub
Patrice Vivin
Rachel Dupays
Thomas Kerforne
Gabriel Vianet
Virginie Manzano
Eric Noll
Pierre-Olivier Ludes
Thien-Nga Chamaraux-Tran
Cédric Cirenei
Djihad Hamroun
Benoit Lebas
Grégoire Andrieu Andrieu
Vincent Etienne
Raphaël Cinotti
Natacha Simon
Denis Frasca
Hélène Beloeil
Amandine Le Gall
Petyo Techev
Ludovic Meuret
Jérémie Joffre
Hervé Dupont
Beny Charbit
Arthur Davy
David Lobo
Jean-Michel Devys
Benjamin Soria
Clémentine Cholet
Cyrus Motamed
Anne Wyniecki
Valérie Billard
Migena Demiri
Clement Millet
Samuel Degoul
Christophe Canevet
Céline Mounier
Flavie Desrumaux
Julia Martinez
Claire Texier
Benoit Voisin
Guillaume Dubreuil
Jacques de Montblanc
Claire Mengelle
Laura Ruscio
Emmanuel Futier
Julie Fayon
Benoit Baietto
Marie Vignaud
Yoann Munier
Bertille Paquette
Diana Saptefrat
Zakia Machroub
Jean-Sébastien Aubert
Georges Abi Abdallah
Nicolas Polge
Najla Dachraoui
Anne Godier
Diane Zlotnik
Hélène Nougue
Darless Clausse
Sabrina Ma
Sherifatou Salami-Adjavon
Patrick Rossignol
Francis Berthier - Inserm
Romain Barthélémy
Gabriel Vianet
Damien Logeart
Peggy Reiner
Karine Pautrat
Alex Hong
Marine Coroir
Claire Mayeur
Jacques Thes
Florent Laverdure
Sofiane Seri
Violeta Bercan
Cristian Radu Ionescu
Caroline Gonnet Pinton
Marc Leone
Nathalie Lesavre
Jeanne Chatelon
Marion Poirier
Adrien Rivory
Stéphanie Roullet
Sean Coeckelenbergh
Leila Toubal
Joanna Ramadan
Karine Nouette-Gaulain
Bruno Ralec - Hôpital d'Instruction des Armées Clermont-Tonnerre
Chloé Thill - Hôpital d'Instruction des Armées Clermont-Tonnerre
Christophe Giacardi - Hôpital d'Instruction des Armées Clermont-Tonnerre
Etienne Montelescaut - Hôpital d'Instruction des Armées Sainte-Anne
Philippe Aries - Hôpital d'Instruction des Armées Clermont-Tonnerre
Benoît Tavernier
Julie Bellet
Romain Delassus
Hélène Tribouillard
Daniel Verzilli
Alice Millot
Audrey de Jong - Université de Montpellier, Physiologie et Médecine Expérimentale du coeur et des muscles - PhyMedExp
Marie Geniez
Virginie Marre
Michaëla Penne
Yvan Pouzeratte
Guillaume Rao
Maxime Coutrot
Alice Blet
Benoit Plaud
Emmanuel Basto
Mathilde Ponsin
Marie-Christine Becq
Maïté Chaussard
Aristide Ntahe
François Depret
Lucie Guillemet
Arnaud Valent
Lyse Flores
Julien Burey
Sarah Feray
Yoann Elmaleh
Sophie Dupeyrat
Thomas Baury
Clémentine Taconet
Thomas Rimmele
Elodie Mazocky
Marie Luce Parrouffe
Catherine Jadaud
Stanislas Abrard
Pierre-Antoine Tronche
Arthur Vial
Emma Aka
Anne-Sophie Bellocq
Jean-François Carabalona
Blandine Fayard
Jean Marie Guyader
Letitia Huriaux
Ingrid Millot
Antoine Lamblin
Marine Dutour
Mathilde Roukhomovsky-Moretti
Pascal Meuret
Nadir Omrani
Barnabé Raymond
Clemence Roy
Florent Sigwalt
Xavier Merindol
Mathieu Desmard
Louis Bourreau
Pierre-Antoine Allain
Charlotte Dei Svaldi
Brenton Alexander
Publication Details: JAMA Cardiology, Vol.332(12), pp.970-978
Identifiers: 9934131309311
Academic Unit: Physiologie et Médecine Expérimentale du coeur et des muscles - PhyMedExp; Initial MAnagement & prevent of acute orGan failures IN critically ill patiEnts - IMAGINE
Language: English
Resource Type: Journal article
Local Fields: hal-04683070