Perioperative medicine & outcomes
Preoperative activation of the renin–angiotensin system and myocardial injury in noncardiac surgery: exploratory mechanistic analysis of the SPACE randomised controlled trial
Primary result · Myocardial injuryResult — go to the resultOdds ratio 1.95 95% CI 1.12–3.39Authors' conclusion
This mechanistic exploratory analysis suggests that effective preoperative RAAS inhibition is associated with lower risk of myocardial injury after noncardiac surgery, independent of stopping or continuing RAAS inhibitors before surgery.
Study context
- Population
- Patients ≥60 yr undergoing elective noncardiac surgery, randomised to continue or stop renin-angiotensin-aldosterone system (RAAS) inhibitors
- Participants
- 52 / 153 / 25
- Comparison
- RAAS activation clusters 1 and 3 vs cluster 2
- Cluster 1n = 52
- Cluster 2n = 153reference
- Cluster 3n = 25
- Primary endpoint
- Myocardial injury (plasma high-sensitivity troponin-T)
Methodological detailsprespecified exploratory analysis, multicentre, unsupervised hierarchical cluster analysis, masked outcome
- Prespecified exploratory analysis
- Multicentre
- Unsupervised hierarchical cluster analysis
- Masked outcome
Primary result
Myocardial injury
Odds ratio
1.95
95% CI 1.12–3.39
P = 0.018
Events by treatment group
Clusters 1 and 3 vs Cluster 2
OR 1.95 (95% CI 1.12–3.39); P = 0.018
As reported in the abstract
Further findings
| Outcome | Mean difference (pg ml-1) (95% CI) | |
|---|---|---|
| NT-proBNP concentrationClusters 1 and 3 vs Cluster 2 | 698 (576–820) | |
| Renin concentrationCluster 2 vs Clusters 1 and 3 | 350 (123–577) | |
| −50005001000Difference, pg ml-1 (linear scale) |
Original publication
Preoperative activation of the renin–angiotensin system and myocardial injury in noncardiac surgery: exploratory mechanistic analysis of the SPACE randomised controlled trial. Br J Anaesth. Published 20 December 2024. doi:10.
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