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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Could preoperative beta-blocker therapy decrease post-CABG atrial fibrillation incidence?
Session:
CO - Prémio Machado Macedo
Speaker:
Rui j. Cerqueira
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.9 Cardiovascular Surgery – Arrhythmias
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rui Cerqueira; Ana Filipa Ferreira; Francisca Saraiva; Raquel Moreira; Mário Jorge Amorim; Paulo Pinho; André Lourenço; Adelino Leite-Moreira
Abstract
<p><strong>Background</strong>: Postoperative atrial fibrillation (PoAF) is the most common arrhythmia following cardiac surgery and could be associated to the patient’s morbidity and mortality. Although beta-blocker therapy is recommended to prevent PoAF, the supporting evidence is poor.</p> <p><strong>Purpose</strong>: The aim of this study was to determine the effect of preoperative beta-blocker medication in PoAF incidence following coronary artery bypass grafting surgery (CABG), and its impact in long-term mortality.</p> <p><strong>Methods</strong>: Retrospective single-center study including consecutive CABG during a 5-year period. Patients with documented episodes of AF or pacing rhythm before cardiac surgery were excluded. Preoperative, surgical and postoperative data were collected through clinical files and informatic databases. Qui-square and independent t-tests were used to compare categorical and continuous data, respectively, between patients with and without PoAF. A multivariate logistic regression model was used to estimate the impact of pre-operative beta-blocker therapy in PoAF. Kaplan-Meier curves, Log Rank test and multivariate Cox regression were used to determine the effect of beta-blocker treatment in long-term survival. The mean follow-up time was 8 years, maximum 13.</p> <p><strong>Results</strong>: We included 1487 patients, mean age of 63±10 years, 79% being male. PoAF occurred in 255 patients (17%), 3±4 days after CABG, the majority pharmacologically cardioverted with amiodarone (95%). These patients were older (67±9 vs. 62±10 years, p<0.001), more frequently hypertensive (75% vs. 69%, p=0.004) and had lower preoperative creatinine clearance (CC) values (73±28 vs. 81±28ml/min, p<0.001) and higher CHA<sub>2</sub>DS<sub>2</sub>–VASc score (2.97±1.68 vs. 2.61±1.56, p=0.001) compared with patients without PoAF. PoAF was determined as an independent predictor of mortality in multivariate cox regression (HR: 1.455, 95% CI: 1.120-1.890, p=0.005). In multivariate analysis, pre-operative beta-blocker therapy did not reveal a preventive effect in PoAF after CABG surgery (OR: 1.015, 95% CI: 0.627-1.642, p=0.952). Both univariate and multivariate analysis showed an improvement in cumulative survival with beta-blocker medication (13-years survival of 65% vs. 55%, Log-rank, p=0.005; HR 0.689, 95% CI: 0.522-0.909, p=0.008).</p> <p><strong>Conclusion</strong>: Although pre-operative beta-blocker therapy did not predict PoAF occurrence after CABG surgery in this retrospective cohort, it showed a significant prognosis benefit regarding long-term survival. Further prospective studies could better address the pathophysiology pathways underlying this positive impact.</p>
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