Preoperative β-Blocker Use in Coronary Artery Bypass Grafting Surgery

Abstract

IMPORTANCE Use of preoperative β-blockers has been associated with a reduction in perioperative mortality for patients undergoing coronary artery bypass grafting (CABG) surgery in observational research studies, which led to the adoption of preoperative β-blocker therapy as a national quality standard.OBJECTIVE To determine whether preoperative β-blocker use within 24 hours of CABG surgery is associated with reduced perioperative mortality in a contemporary sample of patients. DESIGN, SETTING, AND PARTICIPANTSRetrospective analysis of the Society of Thoracic Surgeons National Adult Cardiac database for 1107 hospitals performing cardiac surgery in the United States from January 1, 2008, through December 31, 2012. Participants included 506 110 patients 18 years and older undergoing nonemergent CABG surgery who had not experienced a myocardial infarction in the prior 21 days or any other high-risk presenting symptom. We used logistic regression and propensity matching with a greedy 5-to-1 digit-matching algorithm to examine the association between β-blocker use and the main outcomes of interest.EXPOSURES Preoperative β-blocker use. MAIN OUTCOMES AND MEASURESIncidence of perioperative mortality, permanent stroke, prolonged ventilation, any reoperation, renal failure, deep sternal wound infection, and atrial fibrillation.RESULTS Among the 506 110 patients undergoing CABG surgery who met the inclusion criteria, 86.24% received preoperative β-blockers within 24 hours of surgery. In propensity-matched analyses that included 138 542 patients, we found no significant difference between patients who did and did not receive preoperative β-blockers in rates of operative mortality (1.12% vs 1.17%; odds ratio [OR]

Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery

“…7,8 Another recently published analysis of the Society of Thoracic Surgeons National Adult Cardiac database assessing the impact of preoperative β-blockers on outcomes in patients undergoing CABG excluded patients with previous MI within 21 days with a consideration that the use of β-blockers is well established after acute MI. 9 Besides, our findings showed that patients with a history of MI shared similar risk of cardiac death (HR, 0.88; 95% CI, 0.59–1.31) and new-onset MI (HR, 1.41; 95% CI, 0.91–2.18) after CABG compared with those without previous MI, indicating the protective impact associated with CABG as a highly sophisticated method of restoring blood flow to the myocardium.…”

“…Patients were excluded if they were <18 years of age, had physician-documented contraindications to β-blocker therapy, 9 or underwent CABG combined with valvular or other cardiac surgery. Considering the potential influence of MI history before CABG, this study assessed the use of β-blocker and clinical outcomes in 2 separate cohorts: patients without previous MI and patients with known previous MI.…”

“…A history of MI was defined as last documented previous MI at any time (within or beyond 21 days) before this CABG surgery. 9 …”

“…6–8 Recent analyses of the Society of Thoracic Surgeons National Adult Cardiac database demonstrated no perioperative mortality advantage in patients receiving β-blockers before CABG, which challenged this traditional practice and its use as a quality metric. 9–11 To date, however, very limited evidence has been available on whether long-term therapy with β-blockers is beneficial in CABG patients after hospital discharge. 3,12,13 Furthermore, much less attention has been paid to understanding the combined influence of use at discharge and long-term adherence to β-blockers as a secondary preventive medication.…”

Incidence and Predisposing Factors of Atrial Fibrillation After Coronary Artery Bypass Surgery

“…Moreover, Postoperative postoperative pneumonia, chronic obstructive pulmonary disease and prolonged ventilation periods are also thought to beas important factors in the occurrence of POAF. Although, some studies failed to show the efficacy of preoperative beta blocker use on prevention of POAF, meta-analyses show that beta blockers lower the incidence of POAF and routine use of these agents are suggested by the American Heart Association [8][9][10][11]. Also it is reported in a meta-analysis of twelve clinical trials that preoperative use of statins can decrease incidence of POAF in post-CABG patients [12].…”