1. Home>
2. Specialties>
3. Cardiology>
4. Summary and Comment

Post-CABG Outcomes May Improve with Preoperative Beta-Blocker Use

Presurgery beta-blockers benefited most subgroups of CABG patients in this observational study.

Beta-blockers improve outcomes in a large majority of heart patients, but the effect of beta-blocker use before coronary artery bypass grafting (CABG) on postsurgery morbidity and mortality has not been assessed. These researchers used the Society of Thoracic Surgeons National Adult Cardiac Surgery Database to investigate this matter.

Of 629,877 CABG patients in the database, only 60% had received beta-blockers before surgery. Recent MI, hypertension, worse angina, younger age, and higher LV ejection fraction (LVEF) were the most important predictors of preoperative beta-blocker use. Nonuse was predicted most strongly by presence of heart failure, chronic lung disease, and diabetes.

Compared with patients who did not receive beta-blockers, those who did were less likely to die within 30 days of surgery (2.8% vs. 3.4%, P<0.001) and had fewer major procedural complications -- benefits still evident after adjustment for demographic, clinical, and treatment variables. Similar benefits were seen among most patient subgroups, including women, the elderly, and patients with diabetes or chronic lung disease. Although patients with depressed LVEF generally benefited from beta-blockers, there was a trend toward increased mortality among those with severely depressed LVEF (<30%).

Comment: In this observational study of patients undergoing CABG, preoperative beta-blocker use provided substantial clinical benefits. As the authors note, expanding beta-blocker use within this surgical population will require careful coordination between surgeons and cardiologists. The authors also call for a randomized trial to confirm these findings, but given beta-blockers' known cardiovascular benefits, using these agents both before and after CABG seems reasonable.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology June 14, 2002

Citation(s):

Ferguson TB Jr et al. for the Society of Thoracic Surgeons National Adult Cardiac Surgery Database. Preoperative ß-blocker use and mortality and morbidity following CABG surgery in North America. JAMA 2002 May 1; 287:2221-7.

• Original article (Subscription may be required)
• Medline abstract (Free)