Preoperative Blocker Use and Mortality and Morbidity Following CABG Surgery in North America

Preoperative beta-blocker use is associated with a small but significant reduction in mortality following coronary artery bypass graft (CABG) surgery, according to a report published in the May 1st issue of the Journal of the American Medical Association.

Such treatment has been shown to convey a survival benefit for patients undergoing noncardiac vascular surgery, lead author Dr. T. Bruce Ferguson, from Louisiana State University Health Sciences Center in New Orleans, and colleagues note. However, it was unclear whether preoperative beta-blocker therapy would be beneficial in patients undergoing CABG surgery.

The researchers assessed the value of beta-blocker use by analyzing data from 629,877 patients who underwent CABG between 1996 and 1999. During that time, the percentage of cases in which preoperative beta-blocker therapy was used increased from 50% to 60%.

After adjusting for patient risk and treatment center factors, preoperative beta-blocker use was associated with a small but significant reduction in 30-day mortality, the authors note. In addition, the rates of major procedural complications, such as stroke and prolonged ventilation, were lower in patients who received beta-blockers.

Beta-blocker therapy was associated with to improved outcomes for most patient subgroups, the investigators state. However, in patients with an ejection fraction of less than 30%, the use of such agents corresponded with a nonsignificant increase in mortality.

In North American populations, preoperative beta-blocker use could save about 500 lives each year, the authors estimate. Although the current “results are quite promising, we believe that, ideally, they should be confirmed in a large, randomized clinical trial of preoperative beta-blocker use.”

JAMA 2002;287:2221-2227.