Beta-Blockers Before Coronary Artery Bypass Grafting Surgery Not Associated With Better Outcomes

Beta blockers (Credit: iStockphoto/Thinkstock)Main Point:

Use of beta (β)-blockers in patients who have not had a recent heart attack but were undergoing nonemergency coronary artery bypass grafting (CABG) surgery was not associated with better outcomes.

Published in:

JAMA Internal Medicine

Author:

William Brinkman, M.D., of the Cardiopulmonary Research Science and Technology Institute, Dallas, and colleagues.

Background:

The use of preoperative β-blockers has been associated with a reduction in perioperative mortality for patients undergoing CABG surgery in previous observational studies.  Preoperative β-blocker therapy is a national quality standard.

How the Study Was Conducted:

The authors conducted a retrospective analysis of the Society of Thoracic Surgeons National Adult Cardiac database of U.S. hospitals performing cardiac surgery from 2008 to 2012. The study included 506,110 patients undergoing nonemergency CABG surgery who had not had a heart attack in the previous 21 days or any other high-risk symptoms.

Results:

Of the 506,110 patients, 86.2 percent received preoperative β-blockers within 24 hours of surgery. The authors found no difference between patients who did and did not receive preoperative β-blockers in rates of death due to the operation, stroke, prolonged ventilation, any reoperation, renal failure and deep sternal wound infection. Patients who received preoperative β-blockers did have higher rates of new-onset atrial fibrillation than patients who did not.

Discussion:

“β-blockers are an important and effective tool in the care of patients undergoing cardiac surgery in specific clinical scenarios. However, the empirical use of β-blockers as recommended by the National Quality Forum (without physiologic goals i.e., adequate clinical drug levels) in all patients before CABG may not improve outcomes. A prospective randomized trial with careful attention to adequate dosing and specific drug type may help to answer this question.”

Reference:

William Brinkman MD, Morley A. Herbert PhD, Sean O’Brien PhD, Giovanni Filardo PhD, Syma Prince RN, Todd Dewey MD, Mitchell Magee MD, William Ryan MD, Michael Mack MD. Preoperative β-Blocker Use in Coronary Artery Bypass Grafting Surgery: National Database Analysis. JAMA Intern Med. 2014;174(8):-. doi:10.1001/jamainternmed.2014.2356

Editor’s Note:

Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Preventive B-Blockade in Coronary Artery Bypass Grafting Surgery

In a related commentary, David M. Shahian, M.D., of the Massachusetts General Hospital, Boston, writes: “The study by Brinkman and colleagues is an important and hypothesis-generating observational analysis. However, owing to the limitations discussed above, continued adherence to current [American College of Cardiology/American Heart Association] ACC/AHA guidelines regarding preoperative β-blockade in CABG surgery, together with good medical judgment, is advisable.”

Reference:

David M. Shahian MD. Preoperative β-Blockade in Coronary Artery Bypass Grafting Surgery. JAMA Intern Med. 2014; 174(8):-. doi:10.1001/jamainternmed.2014.155

Editor’s Note:

Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory:

To contact author William Brinkman, M.D., email willibri@baylorhealth.edu. To contact commentary author David M. Shahian, M.D., call Cassandra Aviles at (617) 724-6433 or email cmaviles@partners.org.

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