Beneficial Effects of Consistent Beta-Blocker Therapy After CABG | Journal Scan

Study Questions:

What is the association between chronic beta-blocker use patterns and all-cause mortality following isolated coronary artery bypass grafting (CABG)?

Methods:

This was a prospective study conducted at a single Chinese center; 5,926 consecutive patients who underwent CABG and were discharged alive were included in the analysis. The authors assessed the use of beta-blocker and clinical outcomes in two separate cohorts: those with prior myocardial infarction (MI) within or beyond the 21 days preceding CABG, and those without any history of MI. Data regarding discharge medication were collected by reviewing the hospital discharge summaries (this was considered to be the first expected record of beta-blocker administration). Adherence for a period of 1 year after CABG was determined. Each cohort was categorized into three comparison groups on the basis of patients’ patterns of beta-blocker use: 1) Always users (patients discharged with beta-blockers and reporting use at each interval), 2) Never users (patients discharged without beta-blockers and never reporting use during the interval), and 3) Inconsistent users who did not meet criteria for always or never users. Clinical outcomes were assessed after the 1-year observational interval; the primary outcome was all-cause death.

Results:

The analytic sample included 5,926 patients; 2,514 (42.4%) patients had a documented history of MI before surgery. Median follow-up was 3.0 years (interquartile range, 1.6-5.5). Consistent beta-blocker use after hospital discharge was noted in 2,922 patients (49.3%), whereas 1,323 (22.3%) patients never used beta-blockers. Compared with always users, the risk of all-cause death was significantly higher among inconsistent beta-blocker users (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.50-2.57), and never using beta-blockers was associated with increased risk of both all-cause death (HR, 1.42; 95% CI, 1.01-2.00) and the composite of adverse cardiovascular events (HR, 1.29; 95% CI, 1.10-1.50).

Conclusions:

Among patients with or without an MI, consistent use of beta-blockers after isolated CABG was associated with a lower risk of all-cause death and composite cardiovascular events.

Perspective:

While recent observational data has questioned the value of beta-blockers for decreasing mortality and preventing major cardiac complications in patients with ischemic heart disease, the current analysis reaffirms the benefit of consistent use of beta-blocker therapy in patients undergoing CABG. Certainly future efforts should improve beta-blocker use both at the time of hospital discharge (physician performance) and long-term adherence.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Coronary Artery Disease

Keywords: Acute Coronary Syndrome, Adrenergic beta-Antagonists, Cardiac Surgical Procedures, Coronary Artery Bypass, Coronary Artery Disease, Medication Adherence, Mortality, Myocardial Infarction, Prospective Studies, Risk, Secondary Prevention


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