The association between heart rate and in-hospital mortality after coronary artery bypass graft surgery.
Avoidance of tachycardia is a commonly described goal for anesthetic management during coronary artery bypass graft (CABG) surgery. However, an association between increased intraoperative heart rate and mortality has not been described. We conducted an observational study to evaluate the association between preinduction heart rate (heart rate upon arrival to the operating room) and in-hospital mortality during CABG surgery. Data were collected on 5934 CABG patients. Fifteen percent of patients had an increased preinduction heart rate > or =80 bpm. Crude mortality was significantly more frequent among patients with increased preinduction heart rate (P(trend) = 0.002). After adjustment for baseline differences among patients, preinduction heart rate > or =80 bpm remained associated with increased mortality (P(trend) < 0.001). The increased heart rate may be a cause of the observed mortality. Alternatively, faster heart rate may be either a marker of patients with irreversible myocardial damage, or a marker of patients with limited cardiac reserve at risk for further injury. Lastly, faster heart rate may be a marker for under-use of beta-adrenergic blockade. Because the use of preoperative beta-adrenergic blockade in CABG patients is associated with improved in-hospital survival, further investigation concerning the effect of intraoperative treatment of increased heart rate with beta-adrenergic blockers on mortality after CABG surgery is warranted.


CONCLUSIONS
We conducted an observational study to evaluate the association between heart rate upon arrival to the operating room (preinduction heart rate) and in-hospital mortality during coronary artery bypass graft surgery. After adjustment for baseline differences among patients, preinduction heart rate > or =80 bpm was associated with an increased in-hospital mortality after coronary artery bypass graft surgery.
Fillinger
Mary P
MP
Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. mary.p.fillinger@hitchcock.org
Surgenor
Stephen D
SD
Hartman
Gregg S
GS
Clark
Cantwell
C
Dodds
Thomas M
TM
Rassias
Athos J
AJ
Paganelli
William C
WC
Marshall
Peter
P
Johnson
David
D
Kelly
Dennis
D
Galatis
Dean
D
Olmstead
Elaine M
EM
Ross
Cathy S
CS
O'Connor
Gerald T
GT
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000319:Adrenergic beta-Antagonists