Effect of preoperative renin-angiotensin system blockade on vasoplegia after cardiac surgery: A systematic review with meta-analysis

Table 1 General characteristics of included studies

Ref.	Design	Procedure	Definition of vasoplegia	Total sample	Vasoplegia (%)	ACEI (%)
Tuman et al[14]	Case-control	Coronary artery and/or valve surgery requiring CPB	Post-CPB ≥ 2 vasoconstrictors with adequate cardiac output	4301	4.5	12.1
Bruce et al[16]	Case-control	Cardiac surgery requiring CPB	MAP ≤ 50 mmHg, indexed SVR ≤ 1400 dynes s/cm5/m2, cardiac index ≥ 2.2 L/min/m2, requiring norepinephrine infusion	188	34.0	42.0
Carrel et al[17]	Case-control	CABG or AVR	SVR < 600 dynes s/cm5 with adequate cardiac output	800	7.5	43.1
Mekontso-Dessap et al[7]	Case-control	CABG	MAP < 70 mmHg, indexed SVR ≤ 1400 dynes s/cm5/m2, normal cardiac output, requiring vasoconstrictor	108	33.3	31.5
Sun et al[15]	Case-control	CABG	MAP ≤ 70 mmHg, indexed SVR ≤ 1400 dynes s/cm5/m2, cardiac index ≥ 2.5 L/min/m2, and central venous pressure ≥ 10 mmHg	696	4.7	38.5
Levin et al[2]	Case-control	Cardiac surgery	Epinephrine/norepinephrine (≥ 150 ng/kg/min), dopamine (≥ 10 μg/kg/min) or vasopressin (≥ 4 U/h)	2823	20.4	19.7
Shahzamani et al[6]	Case-control	CABG	MAP < 65 mmHg, normal cardiac output, requiring vasoconstrictor	300	17.0	64.0
Radaelli et al[19]	Case-control	Cardiac surgery	3 of these 4: MAP < 65 mmHg, indexed SVR ≤ 1600 dynes s/cm5/m2, cardiac index ≥ 2.5/min/m2, and requirement of norepinephrine (> 0.03 μg/kg/min) or vasopressin	3139	32.5	52.1
Suga et al[5]	Case-control	CABG	Inotropic support post-CABG	562	11.7	9.1
Miceli et al[18]	Case-control	CABG	Inotropic support post-CABG	2655	43.5	51.0
Pigot et al[21]	RCT	CABG	Inotropic support post-CABG	40	15.0	100
van Diepen et al[20]	RCT	CABG or valve surgery	MAP < 60 mmHg requiring vasopressor administration for at least 4 h and a central venous pressure ≥ 8 mmHg	121	29.8	76.9

ACEI: Angiotensin; AVR: Aortic valve replacement; CABG: Coronary artery bypass graft; CPB: Cardiopulmonary bypass; MAP: Mean arterial blood pressure; RCT: Randomized controlled trial; SVR: Systematic vascular resistance.