Perioperative Beta-Blockers

Discussion in 'General Science & Technology' started by kmguru, Jul 2, 2002.

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  1. kmguru Staff Member

    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%.

    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
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