By: 15 August 2014
Beta-blockers before coronary bypass  may not improve outcome

The use of beta-blockers in patients undergoing non-emergency coronary artery bypass grafting (CABG) surgery is not associated with better outcomes, according to research carried out by William Brinkman and colleagues at the Cardiopulmonary Research Science and Technology Institute in Dallas.

The use of pre-operative beta-blockers has previously been associated with a reduction in peri-operative mortality for patients undergoing CABG surgery and pre-operative beta-blocker therapy is a national quality standard in the USA.

Brinkman and colleagues conducted a retrospective analysis of the Society of Thoracic Surgeons’ national database of US hospitals performing cardiac surgery between 2008 and 2012. The study included over half a million patients undergoing non-emergency CABG surgery who had not had a heart attack in the previous 21 days, nor had any other high-risk symptoms.

Of the 506,110 patients analysed, 86.2% received pre-operative beta-blockers within 24 hours of surgery. The authors found no difference – between patients who did and did not receive pre-operative beta-blockers – in mortality rates due to the operation, stroke, prolonged ventilation, any reoperation, renal failure or deep sternal wound infection. Patients who received pre-operative beta-blockers had higher rates of new-onset atrial fibrillation than patients who did not.

“Beta-blockers are an important and effective tool in the care of patients undergoing cardiac surgery in specific clinical scenarios,” writes Brinkman. “However, the empirical use of beta-blockers as recommended by the National Quality Forum … in all patients before CABG may not improve outcomes. A prospective randomised trial with careful attention to adequate dosing and specific drug type may help to answer this question.”

Brinkman, W., Herbert, M.A., O’Brien, S., et al. (2014) Pre-operative beta-blocker use in coronary artery bypass grafting surgery. JAMA Intern Med. (doi:10.1001/jamainternmed.2014.2356)