Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: a nationwide cohort study.
Eur Heart J
; 38(31): 2421-2428, 2017 Aug 14.
Article
em En
| MEDLINE
| ID: mdl-28472245
ABSTRACT
AIMS:
Beta-blockers vary in pharmacodynamics and pharmacokinetic properties. It is unknown whether specific types are associated with increased perioperative risks. We evaluated perioperative risks associated with beta-blocker subtypes, overall and in patient subgroups. METHODS ANDRESULTS:
We performed a Danish Nationwide cohort study, 2005-2011, of patients treated chronically with beta blocker (atenolol, bisoprolol, carvedilol, metoprolol, propranolol, or other) prior to non-cardiac surgery. Risks of 30-day all-cause mortality (ACM) and 30-day major adverse cardiovascular events (MACE) were estimated using adjusted logistic regression models and odds ratios with 95% confidence intervals. We identified 61 660 patients, most frequently treated with metoprolol (67% of patients, mean age 69 years, 49% males), atenolol (10% of patients, mean age 68 years, 36% males), or carvedilol (9% of patients, mean age 68 years, 60% males). The crude incidences of ACM and MACE were 4.1 and 3.5% in patients with metoprolol, 3.0 and 2.3% with atenolol, and 4.8 and 4.6% with carvedilol. In adjusted models, risks were not significantly different with atenolol (ACM; 1.10 [0.92-1.32], MACE; 1.08 [0.90-1.31]) or carvedilol (ACM; 0.99 [0.85-1.16], MACE; 1.07 [0.92-1.25]), compared with metoprolol. Risks of ACM were significantly lower in prior myocardial infarction patients treated with carvedilol (0.62 [0.43-0.87]) and no different in patients with uncomplicated hypertension (1.41 [0.83-2.40]). Risks did not differ in analyses stratified by age, surgery priority, duration of anaesthesia or surgery risk (all P for interaction >0.05).CONCLUSION:
Risks of ACM and MACE did not systematically differ by beta-blocker subtype. Findings may guide clinical practice and future trials.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Antagonistas Adrenérgicos beta
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Complicações Intraoperatórias
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
País/Região como assunto:
Europa
Idioma:
En
Revista:
Eur Heart J
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Dinamarca