No Mortality Difference Associated with Pre-Operative Beta Blocker Use for Coronary Artery Bypass Grafting Without Recent Myocardial Infarction

Clinical question: Is the use of beta blockers within 24 hours of coronary artery bypass grafting (CABG) surgery without recent myocardial infarction (MI) associated with decreased peri-operative mortality?

Background: Several retrospective observational studies suggest a reduction in peri-operative mortality with CABG surgery if beta blockers are administered prior to surgery. Although the use of beta blockers pre-operatively for CABG is now a quality measure, the use of pre-operative beta blockers is still controversial due to the results of more recent studies, with the observed benefit thought to be driven mainly by patients with recent MI.

Study design: Retrospective cohort analysis.

Setting: More than 1,100 U.S. hospitals.

Synopsis: The Society of Thoracic Surgeons’ National Adult Cardiac Surgery database identified 506,110 adult patients (without MI within 21 days) nonemergently undergoing CABG surgery. Beta blocker use was defined as receiving a beta blocker within 24 hours before surgery. Although most patients (86%) received beta blockers prior to surgery, there was no significant difference in operative mortality, permanent stroke, prolonged ventilation, and renal failure between patients receiving beta blockers and those who did not, although atrial fibrillation (Afib) was more common with pre-operative beta blocker use.

Bottom line: For patients undergoing nonemergent CABG surgery without recent MI, pre-operative beta blocker use is not associated with improved outcomes and is associated with slightly higher rates of Afib.

Citation: Brinkman W, Herbert MA, O’Brien S, et al. Preoperative beta-blocker use in coronary artery bypass grafting surgery: national database analysis. JAMA Intern Med. 2014;174(8):1320-1327.

Clinical question: Is the use of beta blockers within 24 hours of coronary artery bypass grafting (CABG) surgery without recent myocardial infarction (MI) associated with decreased peri-operative mortality?

Background: Several retrospective observational studies suggest a reduction in peri-operative mortality with CABG surgery if beta blockers are administered prior to surgery. Although the use of beta blockers pre-operatively for CABG is now a quality measure, the use of pre-operative beta blockers is still controversial due to the results of more recent studies, with the observed benefit thought to be driven mainly by patients with recent MI.

Study design: Retrospective cohort analysis.

Setting: More than 1,100 U.S. hospitals.

Synopsis: The Society of Thoracic Surgeons’ National Adult Cardiac Surgery database identified 506,110 adult patients (without MI within 21 days) nonemergently undergoing CABG surgery. Beta blocker use was defined as receiving a beta blocker within 24 hours before surgery. Although most patients (86%) received beta blockers prior to surgery, there was no significant difference in operative mortality, permanent stroke, prolonged ventilation, and renal failure between patients receiving beta blockers and those who did not, although atrial fibrillation (Afib) was more common with pre-operative beta blocker use.

Bottom line: For patients undergoing nonemergent CABG surgery without recent MI, pre-operative beta blocker use is not associated with improved outcomes and is associated with slightly higher rates of Afib.

Citation: Brinkman W, Herbert MA, O’Brien S, et al. Preoperative beta-blocker use in coronary artery bypass grafting surgery: national database analysis. JAMA Intern Med. 2014;174(8):1320-1327.

Clinical question: Is the use of beta blockers within 24 hours of coronary artery bypass grafting (CABG) surgery without recent myocardial infarction (MI) associated with decreased peri-operative mortality?

Background: Several retrospective observational studies suggest a reduction in peri-operative mortality with CABG surgery if beta blockers are administered prior to surgery. Although the use of beta blockers pre-operatively for CABG is now a quality measure, the use of pre-operative beta blockers is still controversial due to the results of more recent studies, with the observed benefit thought to be driven mainly by patients with recent MI.

Study design: Retrospective cohort analysis.

Setting: More than 1,100 U.S. hospitals.

Synopsis: The Society of Thoracic Surgeons’ National Adult Cardiac Surgery database identified 506,110 adult patients (without MI within 21 days) nonemergently undergoing CABG surgery. Beta blocker use was defined as receiving a beta blocker within 24 hours before surgery. Although most patients (86%) received beta blockers prior to surgery, there was no significant difference in operative mortality, permanent stroke, prolonged ventilation, and renal failure between patients receiving beta blockers and those who did not, although atrial fibrillation (Afib) was more common with pre-operative beta blocker use.

Bottom line: For patients undergoing nonemergent CABG surgery without recent MI, pre-operative beta blocker use is not associated with improved outcomes and is associated with slightly higher rates of Afib.

Citation: Brinkman W, Herbert MA, O’Brien S, et al. Preoperative beta-blocker use in coronary artery bypass grafting surgery: national database analysis. JAMA Intern Med. 2014;174(8):1320-1327.