Abstract
Perioperative use of β-blocker has been encouraged in patients undergoing non-cardiac surgery despite weak evidence, especially in patients without left ventricular systolic dysfunction (LVSD) or heart failure (HF). This study evaluated the effects of perioperative β-blocker on clinical outcomes after non-cardiac surgery among coronary revascularized patients without LVSD or HF. Among a total of 503 patients with a history of coronary revascularization (either by percutaneous coronary intervention or coronary arterial bypass grafts) undergoing non-cardiac surgery, those without severe LVSD defined by ejection fraction over 30% or HF were evaluated. The primary outcome was a composite of death, myocardial infarction, repeat revascularization, and stroke during 1-year follow-up. Perioperative β-blocker was used in 271 (53.9%) patients. During 1-year follow-up, we found no significant difference in primary outcome between the two groups on multivariate analysis (hazard ratio [HR], 1.01; confidence interval [CI] 95%, 0.56–1.82; P = 0.963). The same result was shown in propensity-matched population (HR, 1.25; CI 95%, 0.65–2.38; P = 0.504). In coronary revascularized patients without severe LVSD or HF, perioperative β-blocker use may not be associated with postoperative clinical outcome of non-cardiac surgery. Larger registry data is needed to support this finding.
Highlights
Coronary heart disease (CHD) is a well-known risk factor of non-cardiac surgery, and nearly half of postoperative mortality is caused by cardiac complications [1,2]. β-blockers, traditionally prescribed for hypertension, are the primary choice of treatment after myocardial infarction (MI) or chronic angina [3,4]
Recent studies suggest that perioperative β-blocker use may not be associated with postoperative clinical outcome in CHD patients, especially when left ventricular function is preserved [11,12,13]
We conducted this study to investigate whether perioperative use of β-blocker is associated with postoperative clinical outcome of non-cardiac surgery in coronary revascularized patients without severe left ventricular systolic dysfunction (LVSD) or heart failure (HF)
Summary
Coronary heart disease (CHD) is a well-known risk factor of non-cardiac surgery, and nearly half of postoperative mortality is caused by cardiac complications [1,2]. β-blockers, traditionally prescribed for hypertension, are the primary choice of treatment after myocardial infarction (MI) or chronic angina [3,4]. Β-blockers have shown improved clinical outcome in patients with chronic heart failure (HF) [5,6] In this regard, they have been recommended as first line therapy for patients with CHD, and been proposed to reduce cardiac complications by moderating hemodynamic response in the perioperative period [2,7,8,9]. We conducted this study to investigate whether perioperative use of β-blocker is associated with postoperative clinical outcome of non-cardiac surgery in coronary revascularized patients without severe left ventricular systolic dysfunction (LVSD) or HF Recent studies suggest that perioperative β-blocker use may not be associated with postoperative clinical outcome in CHD patients, especially when left ventricular function is preserved [11,12,13].
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