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Beta-blockade during noncardiac surgery benefits only those at high CV risk
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During noncardiac surgery, beta-blockade lowered the risk for mortality in those with at least three cardiac risk factors, but raised it among those with no cardiac risk factors, according to recent study data.
The use of perioperative beta-blockade in those at low risk for myocardial ischemic events during noncardiac surgery has been linked to risk for stroke and hypotension, but results from previous studies have been inconsistent, according to the study background.
Mark L. Friedell, MD, and colleagues conducted a retrospective observational analysis of patients who underwent surgery at Veterans Affairs hospitals from October 2008 to September 2013 (n = 12,375 undergoing cardiac surgery; n = 314,114 undergoing noncardiac surgery).
Patients were stratified according to whether they had a beta-blocker dose ordered any time from 8 hours before surgery to 24 hours after. The researchers calculated a 4-point cardiac risk score for each patient: Patients received 1 point each for renal failure, CAD, diabetes and surgery in a major body cavity. Those with a score of 0 were compared with those with a score of 1 or 2 and those with a score of 3 or 4.
The primary endpoint was 30-day mortality after surgery.
Overall, 43.2% of patients received a beta-blocker (cardiac surgery, 69.3%; noncardiac surgery, 42.2%), according to the researchers.
In those undergoing cardiac surgery, beta-blockade did not significantly affect 30-day mortality rates in any cardiac risk score group (no risk factors, OR = 0.7; 95% CI, 0.2-2.49; one or two risk factors, OR = 1.25; 95% CI, 0.9-1.73; three or four risk factors, OR = 1.02; 95% CI, 0.62-1.68), Friedell, from the department of surgery at University of Missouri–Kansas City School of Medicine, and colleagues found.
However, in patients undergoing noncardiac surgery, beta-blockade reduced the risk for 30-day mortality in patients with three or four risk factors (OR = 0.63; 95% CI, 0.43-0.93) but increased the risk for 30-day mortality in patients with no risk factors (OR = 1.19; 95% CI, 1.06-1.35). It had no effect on 30-day mortality among patients with one or two risk factors (OR = 0.95; 95% CI, 0.87-1.03).
“Beta-blockade is beneficial perioperatively for patients with three to four cardiac risk factors undergoing [noncardiac surgery] but not in patients with one to two cardiac risk factors,” Friedell and colleagues wrote. “Most important, the use of beta-blockers in patients with no cardiac risk factors appears to be associated with a higher risk of death, which has, to our knowledge, not been previously reported.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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