Sex-related differences in outcome after high-risk vascular surgery after the administration of beta-adrenergic-blocking drugs.
BACKGROUND
Beta-adrenergic-blocking medications may have a cardioprotective effect after high-risk vascular surgery. This effect has been shown primarily in men and has not been independently shown in women.


METHODS
Retrospective data were collected from vascular surgery (primarily infrainguinal) patients. Adverse outcome was defined as myocardial infarction, new-onset congestive heart failure (CHF), significant arrhythmia, renal failure, or death. The incidence of adverse outcomes was compared independently for both men and women based on the administration of perioperative beta-blockade. Analysis was performed for the whole population and for the subset of patients who were not on preoperative beta-blockers (beta-blocker naïve). Risk-stratified analysis was used to determine which group received any effect from beta-blockade. Logistic regression was performed to determine the independent effect of perioperative beta-blockade in both sexes.


RESULTS
There were 594 men and 366 women. The incidence of adverse outcomes was lower when beta-blockers were administered in men (12.6% v 18.9%, p = 0.04) but not in women (17.8% v 13.7%, p = 0.37). Among beta-blocker-naïve subjects, men had significant reductions in myocardial infarction and renal failure, whereas women did not have a reduction in the incidence of any outcome. After risk-stratification, the high-risk women who received beta-blockade had a statistically worse outcome (36.8% v 5.9%, p = 0.02) because of an increased incidence of CHF. By logistic regression, beta-blockade improved outcomes in men but not women.


CONCLUSIONS
In this retrospective analysis, women did not benefit from perioperative beta-blockade. Women at high risk appeared to have a worse outcome because of a higher incidence of CHF.
Matyal
Robina
R
Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. rmatyal@bidmc.harvard.edu
Mahmood
Feroze
F
Panzica
Peter
P
Pomposelli
Frank
F
Park
Kyung W
KW
Hamden
Allen
A
Schermerhorn
Mark
M
Hess
Philip
P
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D000319:Adrenergic beta-Antagonists