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No difference was seen between a strategy of renin-angiotensin system inhibitors (RASI) discontinuation or RASI continuation in terms of post-operative complications among patients on RASI who underwent major non-cardiac surgery in the STOP-or-NOT trial.
“It is unclear what the impact of RASI continuation versus discontinuation is on post-operative outcomes among patients on RASI therapy who undergo major non-cardiac surgery,” expressed Prof. Matthieu Legrand, MB, BS, PhD, from the University of California, in San Francisco, CA, US1. The multicenter STOP-or-NOT trial (NCT03374449) randomly assigned 2,222 participants scheduled for major non-cardiac surgery 1:1 to RASI discontinuation or RASI continuation. Participants in the discontinuation arm discontinued their RASI 48 hours before the day of surgery, whereas participants in the continuation arm were treated with RASI until the day of surgery. The primary outcome was the major post-operative complication and mortality rate at 28 days after surgery.
In both arms, 22% of the participants had a primary outcome event, displaying no difference between the two 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 two arms delivered similar outcomes regarding length of hospitalization and length of stay at an intensive care unit.
“Both RASI continuation and RASI discontinuation appear acceptable strategies to use for patients on RASI who undergo major non-cardiac surgery, with comparable post-operative complication rates,” concluded Prof. Legrand.
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