The impact of renin-angiotensin system inhibitors on postoperative outcomes following coronary artery bypass grafting: A systematic review

Authors

• Ahmed Mansour, From the Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Ahmed Elazab, Department of Medicine, Faculty of Medicine, South Valley University, Qena, Egypt.
• Ahmed Elbataa, From the Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Abdalhakim Shubietah, Advocate Health - MidwestFollow
• Mohamed Hamouda Elkasaby, From the Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Elsayed Balbaa, Department of Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
• Ahmed Hamdy Ali, Department of Medicine, National Research Ogarev Mordovia State University, Saransk, Mordovia, Russia.
• Ahmed Farid Gadelmawla, Department of Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
• Ahmed Emara, From the Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Hamza A. Abdul-Hafez, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
• Mohammed A. Elbahloul, Department of Medicine, Faculty of Medicine, Kafr El-Shaikh University, Kafr El-Shaikh, Egypt.
• Ahmed W. Hageen, Department of Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
• Mohammed Mhanna, Division of Cardiovascular Medicine, Department of Medicine, University of Iowa, Iowa City, IA; and.
• William H. Frishman, Departments of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY.
• Wilbert S. Aronow, Departments of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY.

Recommended Citation

Mansour A, Elazab A, Elbataa A, et al. The Impact of Renin-Angiotensin System Inhibitors on Postoperative Outcomes Following Coronary Artery Bypass Grafting: A Systematic Review. Cardiol Rev. Published online October 8, 2026. doi:10.1097/CRD.0000000000001488

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Patients undergoing coronary artery bypass grafting (CABG) remain at high risk of major adverse cardiovascular events and death despite successful revascularization, and the role of renin-angiotensin system inhibitors (RASi), comprising angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, in this setting is not clearly defined. We systematically reviewed the effect of RASi initiated within 30 days after CABG on postoperative outcomes. PubMed, Web of Science, Scopus, and the Cochrane Library were searched through May 2025 for randomized controlled trials and observational studies comparing patients who received RASi after CABG, alone or with other cardiovascular medications, with those who did not. Five studies (3 RCTs and 2 retrospective cohorts) comprising 47,821 patients (28,917 RASi recipients and 18,904 controls) were included. RASi use after CABG was generally associated with a lower rate of major adverse cardiovascular events, with the largest reductions observed in patients with heart failure. The effect on all-cause mortality was inconsistent: 2 studies reported a reduced risk, whereas 2 reported no significant difference. Cardiovascular mortality findings were similarly variable, with 1 study showing a marked reduction, 1 an early increase in the composite endpoint that attenuated over longer follow-up, and 1 no significant change.

Type

Article

PubMed ID

42844675