High-Level Highlights
In the management of patients undergoing major noncardiac surgery, the decision to continue or discontinue renin-angiotensin system inhibitors (RASi) has long been a subject of debate. This secondary analysis of the STOP-or-NOT randomized clinical trial provides critical clarity. The key highlights include:
- Preoperative cardiovascular risk, as assessed by the Revised Cardiac Risk Index (RCRI) and the AUB-HAS2 index, does not modify the impact of RASi management on postoperative outcomes.
- The strategy of continuing RASi until the day of surgery was not associated with an increased risk of mortality or major complications compared to discontinuation, regardless of the patient’s baseline cardiovascular risk.
- These findings suggest that clinicians can individualize RASi management without the constraints of traditional cardiovascular risk stratification tools.
