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Perioperative ß-Blockers for CABG Patients

Preoperative ß-blocker therapy makes sense for many patients who undergo coronary-artery bypass grafting.

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

Published in Journal Watch General Medicine May 10, 2002

Citation(s):

Ferguson TB Jr et al. Preoperative ß-blocker use and mortality and morbidity following CABG surgery in North America. JAMA 2002 May 1; 287:2221-7.

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