RS30 - Angiotensin Converting Enzyme Inhibitors is Superior to Beta Blockers in Preventing Mortality and Aneurysmal Rupture Following Open and Endovascular Aneurysm Repair

Objectives: Optimal blood pressure control following endovascular (EVAR) or open abdominal aneurysm repair (OAR) is crucial in reducing post repair complications. In hospital continuation of pre-operative beta blocker (BB) has shown a significant reduction in post-operative mortality following repair. While treatment with angiotensin converting enzyme inhibitors (ACEI) is associated with a reduction in mortality among patients with abdominal aortic aneurysms (AAA) regardless of repair status. Nevertheless, the best medical therapy to control hypertension following AAA repair is yet to be determined. We examined whether treatment with ACEI versus BB influenced postoperative and one-year outcomes following AAA repair in a Medicare-linked database.

Methods: All hypertensive patients undergoing EVAR and OAR in the VQI-VISION between 2003 and 2018 were included. Patients were divided into two groups based on their preoperative and discharge medications either ACEI or BB. Postoperative outcomes included mortality, renal complications, leg ischemia, respiratory complications, pneumonia, and non-home discharge. One-year outcomes included all-cause mortality, aneurysmal rupture, and reintervention. Multivariable logistic regression analysis was used to assess postoperative outcomes and Kaplan-Meier survival and Cox proportional hazard regression analyses were used to evaluate 1-year outcomes.

Results: Our cohort included 8,789 patients, of these 3,523 (40.1%) patients were on ACEI and 5,266 (59.9%) were on BB. Patients on ACEI were more likely to be males (79.8% vs 77.4%, P=0.010), Hispanic (3.5% vs 2.1%, P< 0.001), current smokers (29.7% vs 26.5%, P=0.007), and diabetics (24% vs 19.4%, P< 0.001). Patients on BB had higher rates of CHF (17.3% vs 6.2%, P< 0.001), CKD (43.1% vs 35.5%, P< 0.001), CAD (51.5% vs 25.3%, P< 0.001), and COPD (37.4% vs 32%, P< 0.001). ACEI use was associated with lower risk of postoperative mortality (OR: 0.3, 95%CI(0.1-0.8), P=0.014), leg ischemia (OR: 0.5, 95%CI(0.3-0.98), P=0.043), myocardial infarction (OR: 0.1, 95%CI(0.03-0.5), P=0.004), respiratory complications (OR: 0.5, 95%CI(0.3-0.8), P< 0.001), pneumonia (OR: 0.4, 95%CI(0.2-0.8), P=0.012), renal complications (OR: 0.5, 95%CI(0.3-0.7), P< 0.001), and non-home discharge (OR: 0.47, 95%CI(0.4-0.6), P< 0.001). At one year, ACEI use was associated with lower mortality (HR: 0.5, 95%CI (0.4-0.7), P< 0.001) and lower risk of aneurysmal rupture (HR: 0.7, 95%CI(0.5-0.9), P=0.017)(Figures 1, 2).

Conclusions: In this large contemporary retrospective cohort study, ACEI use was associated with favorable postoperative outcomes compared to BB. It was also associated with lower mortality and aneurysmal rupture at one-year of follow-up. These findings suggest that ACEI may be involved in vascular inflammation reduction of several vascular beds in addition to hypertension control.