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Preoperative β-Blocker Use in Coronary Artery Bypass Grafting Surgery: National Database Analysis
Study Questions:
Is preoperative β-blocker use within 24 hours of coronary artery bypass grafting (CABG) surgery associated with reduced perioperative mortality in a contemporary sample of patients?
Methods:
This was a retrospective study using data from the Society of Thoracic Surgeons National Adult Cardiac database for 1,107 hospitals performing cardiac surgery in the United States from January 1, 2008, through December 31, 2012. Participants included 506,110 patients ages ≥18 years undergoing nonemergent CABG surgery, who had not experienced a myocardial infarction (MI) in the prior 21 days or any other high-risk presenting symptoms. Logistic regression and propensity-matching models were used to examine the association between β-blocker use and the main outcomes of interest (incidence 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, no significant difference between patients who did and did not receive preoperative β-blockers was observed for rates of operative mortality (1.12% vs. 1.17%; odds ratio [OR], 0.96; 95% confidence interval [CI], 0.87-1.06; p = 0.38), permanent stroke (0.97% vs. 0.98%; OR, 0.99; 95% CI, 0.89-1.10; p = 0.81), prolonged ventilation (7.01% vs. 6.86%; OR, 1.02; 95% CI, 0.98-1.07; p = 0.26), any reoperation (3.60% vs. 3.69%; OR, 0.97; 95% CI, 0.92-1.03; p = 0.35), renal failure (2.33% vs. 2.24%; OR, 1.04; 95% CI, 0.97-1.11; p = 0.30), and deep sternal wound infection (0.29% vs. 0.34%; OR, 0.86; 95% CI, 0.71-1.04; p = 0.12). Patients who received preoperative β-blockers within 24 hours of surgery had higher rates of new-onset atrial fibrillation when compared with patients who did not (21.50% vs. 20.10%; OR, 1.09; 95% CI, 1.06-1.12; p < 0.001).
Conclusions:
The investigators concluded that preoperative β-blocker use among patients undergoing nonemergent CABG surgery, who have not had a recent MI, was not associated with improved perioperative outcomes.
Perspective:
These data support the hypothesis that β-blockers do not lower risk in many patients prior to surgery. The observance of increases in atrial fibrillation associated with β-blocker use is interesting and counter to prior reports. It calls into question whether there existed a selection bias where cardiac surgeons and cardiologists used β-blockers more in patients expected to be at high risk for atrial fibrillation.
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