Short-term effects of preoperative beta-blocker use for isolated coronary artery bypass grafting: A systematic review and meta-analysis

J Thorac Cardiovasc Surg. 2018 Feb;155(2):620-629.e1. doi: 10.1016/j.jtcvs.2017.08.025. Epub 2017 Aug 24.

Abstract

Objective: The use of preoperative beta-blockers has been used as a quality standard for patients undergoing coronary artery bypass grafting (CABG). However, the benefits of beta-blockers use before CABG remain controversial. We performed a systematic review and meta-analysis to investigate the short-term effects of preoperative beta-blocker use for patients undergoing isolated CABG.

Methods: We searched PubMed, Embase, and the Cochrane Library for English articles published from inception to August 16, 2016. Observational studies comparing preoperative beta-blockers therapy or non-beta-blockers therapy were considered eligible for the current study.

Results: Six observational studies with 1,231,850 patients were included. The pooled analyses of unadjusted outcome (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71-0.95; P = .007) or risk-adjusted outcome (OR, 0.95; 95% CI, 0.92-0.97; P = .000) showed slight reduction in operative mortality, whereas an insignificant difference in mortality rate was observed in pooling postoperative data from propensity score analysis (OR, 0.97; 95% CI, 0.94-1.00; P = .088). Removing one study that used propensity-score covariate adjustment, subgroup analysis of propensity-matched patients (313,417 in each group) still generated a statistically nonsignificant benefit for preoperative beta-blocker use (OR, 0.97; 95% CI, 0.94-1.00; P = .093). Furthermore, the preoperative use of beta-blockers did not reduce the incidence of major postoperative complications, such as postoperative myocardial infarction, stroke, atrial fibrillation, reoperation, renal failure, prolonged ventilation, and sternal wound infection.

Conclusions: Our study suggests that the use of preoperative beta-blockers did not reduce either operative mortality or the incidence of postoperative complications in patients undergoing CABG.

Keywords: coronary artery bypass grafting; operative mortality; perioperative beta-blocker use.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage*
  • Adrenergic beta-Antagonists / adverse effects
  • Aged
  • Coronary Artery Bypass* / adverse effects
  • Coronary Artery Bypass* / mortality
  • Coronary Artery Disease / drug therapy*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery*
  • Drug Administration Schedule
  • Female
  • Humans
  • Male
  • Middle Aged
  • Observational Studies as Topic
  • Postoperative Complications / mortality
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Adrenergic beta-Antagonists