Does RAS inhibitor discontinuation affect outcomes after non-cardiac surgery?

No difference was seen between a strategy of renin-angiotensin system (RAS) inhibitor continuation or discontinuation in terms of postoperative complications among patients who underwent major non-cardiac surgery in the STOP-or-NOT trial.

“It is unclear what the impact of RAS inhibitor continuation versus discontinuation is on postoperative outcomes among patients on RAS inhibitor therapy who undergo major non-cardiac surgery,” expressed Prof. Matthieu Legrand (University of California San Francisco, CA, USA) [1]. The multicentre STOP-or-NOT trial (NCT03374449) randomised 2,222 participants scheduled for major non-cardiac surgery 1:1 to RAS inhibitor discontinuation or RAS inhibitor continuation.

The participants in the discontinuation arm discontinued their RAS inhibitor 48 hours prior to the day of surgery, whereas participants in the continuation arm were treated with RAS inhibitors until the day of surgery. The primary outcome was the major postoperative complication and mortality rate 28 days after surgery.

In both arms, 22% of the participants had a primary outcome event, displaying no difference between the 2 arms (RR 1.02; 95% CI 0.83–1.25). “There was no difference with respect to individual event types or time-to-event either,” added Prof. Legrand. Finally, the 2 arms showed similar outcomes regarding length of hospitalisation and length of stay at an intensive care unit.

“Both RAS inhibitor continuation and RAS inhibitor discontinuation appear acceptable strategies to use for patients on RAS inhibitors who undergo major non-cardiac surgery, with comparable post-operative complication rates,” concluded Prof. Legrand.

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   1. Legrand M, et al. Renin-angiotensin system inhibitors continuation versus discontinuation before major non-cardiac surgery: the STOP-or-NOT randomised controlled trial. HOTLINE 1, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024