Perioperative Beta-Blockers

Journal Watch (General)
May 10, 2002
Perioperative Beta-Blockers for CABG Patients


from Journal Watch

Physician-authored summaries and commentary
from the publishers of the New England Journal
of Medicine



Recent evidence suggests that perioperative use of ß-blockers may reduce morbidity and mortality among high-risk patients who undergo major noncardiac or vascular surgery (Journal Watch Apr 9 2002). However, there is limited information on ß-blockade during coronary-artery bypass grafting (CABG). In this nonrandomized study, researchers used a North American cardiac surgery database to determine whether preoperative ß-blockers are beneficial for CABG patients.
Among more than 600,000 patients who underwent CABG from 1996 to 1999, 60% received preoperative ß-blockers. Operative mortality was significantly lower among ß-blocker recipients than among those who did not receive ß-blockers (2.8% vs. 3.4%). When adjustments were made for multiple confounding variables, mortality remained slightly, but significantly, lower among ß-blocker recipients. The benefit of ß-blockade was noted in all prespecified subgroups except patients with ejection fractions lower than 30%.


Comment
Although one should be cautious about drawing conclusions from this observational study, a beneficial effect of ß-blocker therapy makes sense. We don't know the optimal dose, timing, or duration of therapy from this database. Nevertheless, one should at least consider starting ß-blockers before CABG, unless the patient has severe left ventricular dysfunction.
— Allan S. Brett, MD