Evidence map›Paper›PMID 22824930›Full record

Trial reportCritical care medicine2012

Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery.

Mias Pretorius, Katherine T Murray, Chang Yu, John G Byrne, Frederic T Billings, Michael R Petracek, James P Greelish, Steven J Hoff, Stephen K Ball, Vineet Mishra and 2 more

3 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 27 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 8 pooled it
2.5field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00141778 phase2 / phase3completednot on this map

RAAS, Inflammation, and Post-operative AF

TypeinterventionalSponsorVanderbilt UniversityRan2005 to 2010Enrolled455ConditionsAtrial FibrillationArmsPlacebo, Ramipril, Spironolactone
NCT02417896 naunknown statusnot on this mapstarted 2013, after this paper: background citation

Pilot Non Randomised Controlled Trial of Short Term Spironolactone Use for Prevention of Acute Kidney Injury After Cardiac Surgery

TypeinterventionalSponsorInstituto Nacional de Cardiologia Ignacio ChavezRan2013 to 2015Enrolled150ConditionsAcute Kidney Injuries, Kidney Injuries, Acute, Kidney Injury, Acute, Acute Renal InjuryArmsSpironolactone
NCT03206658 phase3unknown statusnot on this mapstarted 2017, after this paper: background citation

Usefulness of Spironolactone for the Prevention of Acute Kidney Injury in Critically Ill Patients With Invasive Mechanical Ventilation

TypeinterventionalSponsorInstituto Nacional de Ciencias Medicas y Nutricion Salvador ZubiranRan2017 to 2019Enrolled90ConditionsAcute Kidney InjuryArmsSpironolactone 25 mg, Placebo oral capsule
3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 8 syntheses or guidelines pooled it, 64 citations in OpenAlex.

  1. Diuretics for preventing and treating acute kidney injury.The Cochrane database of systematic reviews · 2025
    Pooled it
  2. Pooled it
  3. Pooled it
  4. Perioperative Clinical Trials in AKI.Seminars in nephrology · 2020
    Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Trial
  10. Trial
  11. Article
  12. Article
  13. Review
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  17. Observational
  18. Article
  19. Medication management on sick days.Australian prescriber · 2017
    Review
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 1 institution in 1 country.

Mias PretoriusDepartment of Anesthesiology, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN, USA. mias.pretorius@vanderbilt.edu
Katherine T Murray
Chang Yu
John G Byrne
Frederic T Billings
Michael R Petracek
James P Greelish
Steven J Hoff
Stephen K Ball
Vineet Mishra
Simon C Body
Nancy J Brown
Vanderbilt University · US

Funding

VANDERBILT UNIVERSITY CTSA FOR PEDIATRIC RESEARCHUL1RR024975 · NCRR · VANDERBILT UNIVERSITY · PI BERNARD, GORDON RAPHAEL · 2007 to 2011
$45.7M
The Vanderbilt Institute for Clinical and Translational Research (VICTR) KL2KL2RR024977 · NCRR · VANDERBILT UNIVERSITY · PI BERNARD, GORDON RAPHAEL · 2007 to 2011
$3.0M
RAAS, Inflammation &Post-Operative Atrial FibrillationR01HL077389 · NHLBI · VANDERBILT UNIVERSITY · PI BROWN, NANCY J. · 2005 to 2009
$2.7M
Identification of Genetic and Molecular Mechanisms of Atrial FibrillationR01HL098601 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI BODY, SIMON C · 2010 to 2014
$2.2M
Bradykinin Receptor Antagonism During Cardiopulmonary BypassR01HL085740 · NHLBI · VANDERBILT UNIVERSITY · PI PRETORIUS, MIAS · 2006 to 2010
$2.0M
Preamyloid Oligomers and Susceptibility to Atrial FibrillationR01HL096844 · NHLBI · VANDERBILT UNIVERSITY · PI MURRAY, KATHERINE T · 2010 to 2014
$1.9M
A Molecular Target for Atrial FibrillationR01HL071002 · NHLBI · VANDERBILT UNIVERSITY · PI MURRAY, KATHERINE T · 2003 to 2007
$1.9M
The Vanderbilt Institute for Clinical and Translational Research (VICTR) TL1TL1RR024978 · NCRR · VANDERBILT UNIVERSITY · PI BERNARD, GORDON RAPHAEL · 2007 to 2011
$1.3M
NCRR NIH HHS KL2 RR024977NCRR NIH HHS TL1 RR024978NCRR NIH HHS UL1 RR024975NHLBI NIH HHS HL071002NHLBI NIH HHS HL077389NHLBI NIH HHS HL085740NHLBI NIH HHS R01 HL071002NHLBI NIH HHS R01 HL077389NHLBI NIH HHS R01 HL085740NHLBI NIH HHS R01 HL096844NHLBI NIH HHS R01 HL098601
6 · The paper itself

Abstract

objectiveThis study tested the hypothesis that interruption of the renin-angiotensin system with either an angiotensin-converting enzyme inhibitor or a mineralocorticoid receptor antagonist will decrease the prevalence of atrial fibrillation after cardiac surgery.

designRandomized double-blind placebo-controlled study.

settingUniversity-affiliated hospitals. PATIENTS: Four hundred forty-five adult patients in normal sinus rhythm undergoing elective cardiac surgery.

interventionsOne week to 4 days prior to surgery, patients were randomized to treatment with placebo, ramipril (2.5 mg the first 3 days followed by 5 mg/day, with the dose reduced to 2.5 mg/day on the first postoperative day only), or spironolactone (25 mg/day). MEASUREMENTS: The primary endpoint was the occurrence of electrocardiographically confirmed postoperative atrial fibrillation. Secondary endpoints included acute renal failure, hyperkalemia, the prevalence of hypotension, length of hospital stay, stroke, and death. MAIN

resultsThe prevalence of atrial fibrillation was 27.2% in the placebo group, 27.8% in the ramipril group, and 25.9% in the spironolactone group (p=.95). Patients in the ramipril (0.7%) or spironolactone (0.7%) group were less likely to develop acute renal failure than those randomized to placebo (5.4%, p=.006). Patients in the placebo group tended to be hospitalized longer than those in the ramipril or spironolactone group (6.8±8.2 days vs. 5.7±3.2 days and 5.8±3.4 days, respectively, p=.08 for the comparison of placebo vs. the active treatment groups using log-rank test). Compared with patients in the placebo group, patients in the spironolactone group were extubated sooner after surgery (576.4±761.5 mins vs. 1091.3±3067.3 mins, p=.04).

conclusionsNeither angiotensin-converting enzyme inhibition nor mineralocorticoid receptor blockade decreased the primary outcome of postoperative atrial fibrillation. Treatment with an angiotensin-converting enzyme inhibitor or mineralocorticoid receptor antagonist was associated with decreased acute renal failure. Spironolactone use was also associated with a shorter duration of mechanical ventilation after surgery.

Indexed as

AgedAngiotensin-Converting Enzyme InhibitorsAtrial FibrillationBlood PressureCardiac Surgical ProceduresDouble-Blind MethodElectrocardiographyFemaleHospitals, UniversityHumansMaleMiddle AgedRamiprilReceptors, MineralocorticoidRenin-Angiotensin SystemSpironolactoneAngiotensin-Converting Enzyme InhibitorsRamiprilReceptors, MineralocorticoidSpironolactone

Identifiers

PMID22824930
PMCPMC3588582
OpenAlexW2090472532

What OpenQuestion holds

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LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.