Comparative Efficacy of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers after Coronary Artery Bypass Grafting

Although angiotensin receptor blockers (ARBs) are considered as an alternative for those with angiotensin converting enzyme inhibitors (ACEi) intolerance, the comparative effectiveness of ARBs and ACEi remains controversial in patients who underwent coronary artery bypass grafting (CABG). We aimed to compare the clinical effects of the two types of renin-angiotensin-aldosterone system (RAAS) inhibitors in patients who underwent CABG. From January 2001 to January 2015, among the 5456 patients, data from 1198 (20.1%) patients who used a RAAS inhibitor at discharge were analyzed. These 1198 patients were classified into ACEi (N = 900) and ARB (N = 298) groups. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE) during a median follow-up period of 48 months. Propensity-matched analysis revealed that the incidence of MACCE over a 48 month follow-up period did not differ between the groups (HR, 0.65; 95% CI, 0.36–1.21; p = 0.17), but it was significantly lower in the ARB group during the 12 month follow-up period (HR, 0.46; 95% CI, 0.22–0.96; p = 0.04). In conclusion, ARBs may have comparable protective effects to ACEi and be a reasonable alternative for intolerant patients after CABG. The beneficial effects of ARBs depending on follow-up period require further investigation.