Preop Beta-Blockers No Benefit Before CABG

Major Finding: The use of preoperative beta-blockers before CABG showed no difference between events, compared with untreated, matched patients.

Data Source: A propensity-matched retrospective study using data from the STS National Database.

Disclosures: Dr. Brinkman reported being on the speakers bureau of the Medicines Company; all authors had an ownership interest in the Heart Hospital Baylor Plano. Some of the authors had a financial relationship with heart device companies.

SAN DIEGO – Since 2007, the use of preoperative beta-blockers has been a quality standard for patients undergoing coronary artery bypass graft surgery. However, a study by Dr. William T. Brinkman of the Cardiopulmonary Research Science and Technology Institute, Dallas, and his colleagues found no evidence that perioperative beta-blocker usage before CABG was beneficial.

Using 2000–2008 data from the STS National Database, Dr. Brinkman and his colleagues compared outcomes between two propensity-matched groups obtained from their overall study group. These subgroups comprised 4,474 patients who received preoperative beta-blockers and 4,474 who did not.

In the propensity-matched groups, there was no difference between event rates in patients treated with beta-blockers and those who were not. However, significantly more beta-blocker-treated patients required intraoperative blood product use. Calculating the adjusted odds ratios showed that the preoperative use of beta-blockers was not an independent predictor of mortality in either group, Dr. Brinkman said at the meeting.

In the remaining unmatched cohort from the overall group study patients, only deep sternal infection (in 0.3% with beta-blocker and 0.5% without), pneumonia (1.9% and 2.4%, respectively), and intraoperative blood usage (37.2% vs. 34.1%) reached statistical significance.

“We were unable to substantiate any benefit to routine use of preoperative beta-blocker therapy. Our findings do not support continued use of preoperative beta-blockade as a quality indicator for CABG,” Dr. Brinkman said in an interview.

“This illustrates the importance of cardiac surgeon participation in decisions regarding quality and value in cardiac surgery.”

Discussant Dr. David M. Shahian, chair of the STS National Database Workforce – which has advocated beta-blocker use as a quality control measure – stated that he disagreed with the conclusions of Dr. Brinkman's study. “There are now almost 30 randomized clinical trials that demonstrate on average a 60% reduction in the odds of postoperative atrial fibrillation with the use of perioperative beta-blockade.” Because of this and other benefits for patients with various heart conditions, the use of these drugs has had long-standing support, unless contraindicated. “For beta-blockade–naive patients, beginning therapy as far in advance of surgery as possible, and titration to optimal heart rate, are the safest and most efficacious strategies,” Dr. Shahian added.

'Our findings do not support continued use of preoperative beta-blockade as a quality indicator for CABG.'

Source DR. BRINKMAN