Evidence map›Paper›PMID 41513520›Full record

Trial reportBritish journal of anaesthesia2026

Impact of continuing renin-angiotensin-aldosterone system inhibitors before surgery on intraoperative hypotensive events: a secondary analysis of the STOP-or-NOT Trial.

Romain Pirracchio, Bernard Cholley, Jeremy Falcone, Hélène Charbonneau, Amélie Delaporte, Adrien Lemoine, Alexandre Joosten, Etienne Gayat, Matthieu Legrand, STOP-or-NOT trial group

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in British journal of anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03374449 (Impact of Renin-Angiotensin System Inhibitors Continuation on Outcome After Major Surgery), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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.

NCT03374449 nacompletednot on this map

Impact of Renin-Angiotensin System Inhibitors Continuation on Outcome After Major Surgery : a Multicenter, Prospective, Randomized and Controlled Trial

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2018 to 2023Enrolled2,222ConditionsRenin Angiotensin System, SurgeryArmscontinuation of the RAS-inhibitors, discontinuation of the RAS-inhibitors
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Romain PirracchioDepartment of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA.
Bernard CholleyDepartment of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
Jeremy FalconeCentre Hospitalier Universitaire de Lille, Hôpital Huriez, Lille, France.
Hélène CharbonneauDepartment of Anesthesiology and Intensive Care Unit, Clinique Pasteur, Toulouse, France.
Amélie DelaporteDepartment of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Adrien LemoineService d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital Tenon, APHP, Sorbonne Université, Paris, France.
Alexandre JoostenDepartment of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Etienne GayatUniversité Paris Cité, AP-HP, Hôpital Lariboisière, DMU PARABOL, Service d'Anesthésie-Réanimation-CTB, Paris, France; Inserm U942 MASCOT, Paris, France; French Clinical Research Infrastructure Network Initiative-Cardio Renal Clinical Trialists Network, Nancy, France.
Matthieu LegrandDepartment of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA; French Clinical Research Infrastructure Network Initiative-Cardio Renal Clinical Trialists Network, Nancy, France. Electronic address: Matthieu.legrand@ucsf.edu.
STOP-or-NOT trial group

Funding

The choice of vasopressor to prevent postoperative acute kidney injury after major non-cardiac surgery: a multicenter pragmatic cluster cross-over randomized trial (the VEGA-2 trial)R01DK139484 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI SACHIN KHETERPAL, Matthieu Legrand · 2024 to 2026
$2.0M
Identification of sub-phenotypes of severely ill burn patients and risk for secondary sepsis: SEPSISBURNR01GM151494 · NIGMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Matthieu Legrand · 2023 to 2026
$1.5M
NIDDK NIH HHS R01 DK139484NIGMS NIH HHS R01 GM151494
6 · The paper itself

Abstract

backgroundThe multicentre STOP-or-NOT trial has shown that continuation of renin-angiotensin-aldosterone inhibitors (RAASis) before major noncardiac surgery did not increase the rate of postoperative complications, but led to a higher incidence of intraoperative hypotension. However, the risk of intraoperative hypotension could vary significantly between patients. We evaluated whether there is heterogeneity in the risk of intraoperative hypotension among patients who continue vs those who discontinue RAASi therapy before major surgery.

methodsWe conducted a secondary analysis of the STOP-or-NOT trial. The primary outcome was intraoperative hypotension (defined as a mean arterial pressure <60 mm Hg) requiring vasopressor administration. We assessed for the presence of significant heterogeneity of treatment effect (HTE). When HTE was statistically significant, we estimated the conditional average treatment effect (CATE) using a machine learning approach. On the basis of CATE estimates, patients were stratified into three risk groups: high-risk (top 20%), low-risk (bottom 5%), and medium-risk (remaining 75%).

resultsAmong 2007 patients, there was a statistically significant HTE for the risk of hypotension. Compared with the low-risk group, patients in the high-risk group (CATE risk difference, 0.172 [0.161-0.179]) were younger (62 vs 69 yr; P<0.001) and had a higher BMI (34 vs 27k m

conclusionsOur analysis supports the existence of significant heterogeneity in the risk of intraoperative hypotension associated with the continuation of RAASi therapy before major noncardiac surgery. CLINICAL

trial registrationNCT03374449.

Indexed as

Angiotensin-Converting Enzyme InhibitorsHypotensionIntraoperative ComplicationsRenin-Angiotensin SystemAgedFemaleHumansMaleMiddle AgedTreatment Effect HeterogeneityAngiotensin-Converting Enzyme Inhibitorsanaesthesiaangiotensinhypotensionmachine learningreninsurgery

Identifiers

PMID41513520
PMCPMC13323963

What Socratic holds

Textmetadata
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 Socratic graph.