From the Guidelines
Captopril should be used post-CABG to improve cardiac outcomes, particularly in patients with hypertension, left ventricular dysfunction, or heart failure, as it reduces afterload on the heart, decreases myocardial oxygen demand, and prevents adverse cardiac remodeling. According to the 2011 ACCF/AHA guideline for coronary artery bypass graft surgery 1, ACE inhibitors like captopril should be reinstituted postoperatively once the patient is stable, unless contraindicated, and should be initiated postoperatively and continued indefinitely in CABG patients who were not receiving them preoperatively, who are stable, and who have an LVEF less than or equal to 40%, hypertension, diabetes mellitus, or CKD. The use of captopril post-CABG has been shown to preserve graft patency and reduce the risk of subsequent cardiovascular events. Some key points to consider when using captopril post-CABG include:
- Starting at a low dose and gradually titrating up as tolerated
- Monitoring for potential side effects such as hypotension, hyperkalemia, and renal dysfunction
- Regularly checking blood pressure, renal function, and potassium levels, especially in the early postoperative period
- Continuing captopril indefinitely in patients with LVEF less than or equal to 40%, hypertension, diabetes mellitus, or CKD, unless contraindicated, as recommended by the guideline 1.
From the Research
Use of Captopril Post-CABG
- Captopril, an angiotensin-converting enzyme (ACE) inhibitor, is used post-coronary artery bypass grafting (CABG) to reduce morbidity and mortality rates in patients with ischemic heart disease 2.
- The use of ACE inhibitors, including captopril, has been shown to induce significant reduction in morbidity and mortality rates in patients with myocardial infarction and a wide range of ventricular function 2.
- Studies such as SOLVD, SAVE, AIRE, GISSI-III, ISIS-IV, and the Chinese Captopril Trial suggest that therapy with ACE inhibitors, including captopril, can improve survival and reduce major ischemic events in patients with depressed systolic ventricular function 2.
- The benefits of ACE inhibitors, including captopril, are thought to be due to their ability to attenuate the detrimental effects of left ventricular remodelling, as well as their cardioprotective and vasculoprotective actions 3.
Post-CABG Medical Therapy
- Optimal medical therapy after CABG includes the use of ACE inhibitors, such as captopril, to reduce the risk of cardiovascular events and death 4.
- Recent developments in lipid-lowering, diabetes management, antithrombotic therapy, and anti-inflammatory therapy can also improve prognosis in patients with chronic coronary artery disease 4.
- The use of ACE inhibitors, including captopril, is recommended in patients with depressed systolic function, whether they are symptomatic or not, and in patients with large anterior wall myocardial infarction, even without objective evidence of left ventricular systolic dysfunction 2.
Complications Post-CABG
- Patients who have undergone CABG are at risk of various complications, including sternal wound infections, pneumonia, thromboembolic phenomena, graft failure, atrial fibrillation, pulmonary hypertension, pericardial effusion, strokes, renal injury, gastrointestinal insults, and hemodynamic instability 5.
- The use of ACE inhibitors, including captopril, may help to reduce the risk of some of these complications by improving cardiac function and reducing blood pressure 2, 6.