Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery
The Stop-or-Not Randomized Clinical Trial
Key Points
Question: Does continuing renin-angiotensin system inhibitors (RASIs) before major noncardiac surgery improve postoperative outcomes?
Findings: In a randomized trial of 2222 patients, the rate of all-cause mortality and major postoperative complications was 22% in both the discontinuation and continuation groups.
Meaning: Continuing RASIs before surgery does not increase the risk of major complications compared to discontinuing them.
Study Overview
Objective
To determine whether continuing RASIs before major noncardiac surgery reduces postoperative complications.
Methods
Design: Multicenter randomized clinical trial.
Participants: 2222 patients treated with RASIs for at least 3 months, undergoing major noncardiac surgery at 40 hospitals in France.
Intervention: Patients were randomly assigned to continue RASIs (n=1107) or discontinue RASIs 48 hours before surgery (n=1115).
Results
- Primary outcome (mortality and major complications at 28 days): 22% in both groups.
- Intraoperative hypotension: 41% in the discontinuation group vs. 54% in the continuation group.
- No significant differences in other secondary outcomes.
Conclusion
Continuing RASIs before surgery does not significantly increase postoperative complications compared to discontinuation.
Comparison of Outcomes: Continuation vs Discontinuation of RASIs
Source: Legrand, M., Falcone, J., Cholley, B., et al. (2024). Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery: The Stop-or-Not Randomized Clinical Trial. JAMA, 332(12), 970-978. https://doi.org/10.1001/jama.2024.17123