Effect of preoperative beta-blockade on perioperative mortality in coronary surgery.
BACKGROUND
Many preoperative factors can influence perioperative mortality in cardiac surgery. Because the perioperative use of beta-blocking agents may reduce perioperative cardiac complications in non-cardiac surgery, we considered the possibility that beta-blocking agents could improve survival in coronary surgery patients.


METHODS
In a retrospective study on 1586 patients undergoing coronary bypass surgery, the relative risk of 30-day mortality was determined in relation to preoperative risk factors and medication. Factors included patient characteristics, pre-existing illness, specific cardiovascular risk factors, cardiac status and urgency of surgery. Treatment with beta-blocking agents, calcium antagonists, angiotensin-converting enzyme inhibitors, nitrates, anti-arrhythmic agents, diuretics and antithrombotic agents was taken into account.


RESULTS
Sex, age, chronic obstructive pulmonary disease, urgency and the preoperative use of diuretics and chronic beta-blocking therapy were found to be linked to mortality (P<0.05). Backward stepwise regression testing identified age, urgency and beta-blocking therapy as independent factors that could predict mortality.


CONCLUSIONS
Increasing age and urgency of surgery are associated with greater mortality, whereas preoperative beta-blocking therapy is associated with less mortality. The characteristics of patients who received chronic beta-blockade did not differ significantly from those of patients who did not. The results suggest that chronic preoperative beta-blocker therapy reduces 30-day mortality in coronary surgery.
ten Broecke
P W C
PW
Department of Anaesthesia, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. pietertenbroeke@hotmail.com
De Hert
S G
SG
Mertens
E
E
Adriaensen
H F
HF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D011182:Postoperative Care / Q000401:mortality; D011300:Preoperative Care / Q000379:methods / Q000401:mortality; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists