Abstract
BackgroundThe use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery. However, conflicting results from recent studies have raised questions concerning the effectiveness of this quality metric. We sought to determine the influence of preoperative beta-blocker administration before CABG in patients with left ventricular dysfunction.MethodsThe authors analyzed all cases of isolated CABGs in patients with left ventricular ejection fraction less than 50%, performed between 2012 January and 2017 June, at 94 centres recorded in the China Heart Failure Surgery Registry database. In addition to the use of multivariate regression models, a 1–1 propensity scores matched analysis was performed.ResultsOf 6116 eligible patients, 61.7% received a preoperative beta-blocker. No difference in operative mortality was found between two cohorts (3.7% for the non-beta-blockers group vs. 3.0% for the beta-blocker group; adjusted odds ratio [OR] 0.82 [95% CI 0.58–1.15]). Few differences in the incidence of other postoperative clinical end points were observed as a function of preoperative beta-blockers except in stroke (0.7% for the non-beta-blocker group vs. 0.3 for the beta-blocker group; adjusted OR 0.39 [95% CI 0.16–0.96]). Results of propensity-matched analyses were broadly consistent.ConclusionsIn this study, the administration of beta-blockers before CABG was not associated with improved operative mortality and complications except the incidence of postoperative stroke in patients with left ventricular dysfunction. A more granular quality metric which would guide the use of beta-blockers should be developed.
Highlights
The use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery
According to the preoperative profiles, women accounted for 16.2% of the patients, and 34.0% of the overall patient population had diabetes mellitus; the mean patient age was 61.3 ± 9.2 years
Patients receiving beta-blockers were more likely to have diabetes mellitus (DM), hypertension prior percutaneous transluminal coronary angioplasty (PTCA) history and left main Coronary artery disease (CAD) while hyperlipidemia, chronic obstructive pulmonary disease (COPD), Carotid disease and triple vessel disease were less common in these patients (Table 1)
Summary
The use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery. Since 2007, the use of preoperative beta-blockers has been used as a quality standard for patients undergoing CABG [8]. Controversies still exist in the literature regarding the effectiveness of beta-blockers for patients undergoing CABG [9,10,11,12]. These studies failed to show perioperative mortality advantage in patients receiving beta-blockers before surgery. A recently meta-analysis suggests that the use of preoperative beta-blockers did not reduce either operative mortality or the incidence of postoperative complications [13]. The preoperative use of beta-blockers as a quality indicator has been questioned
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