There was no difference in major post-operative complications in patients who continued vs. stopped renin-angiotensin system inhibitors (RASIs) before non-cardiac surgery, according to late-breaking research presented in a Hot Line session today at ESC Congress 2024. Many patients who undergo major surgery have a history of hypertension, diabetes or heart failure, and receive chronic treatment with a RASI, namely an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB).
Due to a lack of conclusive data from randomised trials, whether to stop RASIs before non-cardiac surgery is uncertain. RASI continuation might lead to intra-operative hypotension, which could result in post-operative cardiovascular events and acute kidney injury (AKI). On the other hand, RASI discontinuation might cause post-operative hypertension, heart failure or arrhythmias.
The STOP-or-NOT trial was conducted to clear up uncertainties and we showed no differences in major post-operative outcomes between stopping or not stopping RASIs." Matthieu Legrand, Principal Investigator, Professor, University of California at San Francisco, USA The STOP-or-NOT trial was an open-label, randomized, controlled trial conducted in 40 French centers. Patients scheduled for elective major non-cardiac surgery who were chronically treated with ACEIs or ARBs for at least 3 months before surgery were randomized 1:1 to continue RASIs until the day of surgery or to discontinue them 48 hours prio.