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Effect of pre-operative ß-blocker therapy after CABG surgery: long-term survival and postoperative complications
Session:
Painel 11 -Cardiologia Intervenção 1
Speaker:
Fernando Gonçalves
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Posters
FP Number:
---
Authors:
Fernando Gonçalves; Raquel Moreira; Rui Cerqueira; Francisca Saraiva; Ana Filipa Ferreira; Mário Jorge Amorim; Paulo Pinho; André Lourenço; Adelino Leite-Moreira
Abstract
<p><strong>Background:</strong> Perioperative medication in cardiac surgery recommends β-blockers’ use but it is not clear if its prescription should be started before or after cardiac surgery.</p> <p><strong>Purpose: </strong>To determine the effect of preoperative β-blocker therapy in long-term survival and postoperative complications after coronary artery bypass grafting surgery (CABG). Also, to study if recent acute myocardial infarction (AMI) changes this therapeutic effect.</p> <p><strong>Methods: </strong>Retrospective single-center study including consecutive patients submitted to first isolated CABG in 2006-2007. Data was collected through clinical files and informatic databases. Patients were grouped according to their preoperative B-blocker regimen: without (noBB) or with β-blockers (BB). Chi-square, independent t-tests, Kaplan-Meier curves, Log Rank test and multivariable Cox regression were used. The mean follow-up time was 10 years, maximum 13 years.</p> <p><strong>Results: </strong>We included 562 patients, 468 (83%) were on preoperative β-blocker therapy. BB patients were younger (63±10 vs. 66±11, p=0.01) and predominantly male (79% vs. 75%, p=0.30). Recent myocardial infarction occurred in 46% BB vs. 53% noBB, (p=0.23) and BB patients presented less frequently moderate to severe left ventricular dysfunction (19% vs. 32%, p<0.01), history of stroke or transient ischemic attack (5% vs. 11%, p=0.04) and were less often in preoperative critical state (3% vs. 9%, p=0.01). Kaplan-Meier analysis showed an improvement in cumulative survival in BB group (13-years survival: 66% vs. 57%, Log-rank, p=0.01). After stratification by preoperative recent AMI occurrence, patients in BB group had better cumulative survival within patients with recent AMI (63% vs. 48%, Log-rank test p<0.01, BB vs. noBB, respectively), while preoperative β-blocker therapy had no impact on 13 years’ survival in patients without recent AMI (70% vs. 67%, Log-rank test p=0.73). After multivariable Cox regression, preoperative β-blocker therapy emerged as a protective agent (HR: 0.56, 95% CI: 0.39-0.81, p<0.01). This effect is maintained in patients with recent AMI (n=267, HR: 0.38, 95% CI: 0.22-0.65, p<0.01) but lost significance in patients without this event (n=295, HR: 0.99 95% CI: 0.55-1.80, p=0.98). There were no significant differences in postoperative complications.</p> <p><strong>Conclusion:</strong> In this study, β-blocker therapy showed a beneficial effect on long-term survival, particularly in patients with recent AMI. However, we consider that subsequent studies should be performed in order to elaborate more solid conclusions.</p>
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