Neuroprotection is associated with β-adrenergic receptor antagonists during cardiac surgery: Evidence from 2,575 patients

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 16; no. 3; pp. 270 - 277
• Main Authors: Amory, David W., Grigore, Alina, Amory, John K., Gerhardt, Mark A., White, William D., Smith, Peter K., Schwinn, Debra A., Reves, J.G., Newman, Mark F.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-06-2002; Elsevier
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Biological and medical sciences; cardiac surgical procedures; coma; Coma - etiology; Coma - prevention & control; Coronary Artery Bypass; coronary artery bypass graft (CABG) surgery; Female; Humans; Intraoperative Care; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - prevention & control; Male; Medical sciences; Middle Aged; neurologic complications; neuroprotection; Neuroprotective Agents - administration & dosage; Neuroprotective Agents - therapeutic use; Postoperative Complications - prevention & control; Preoperative Care; Retrospective Studies; stroke; Stroke - etiology; Stroke - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; transient ischemic attack (TIA); β-adrenergic blockers; β-adrenergic receptor (βAR); transient ischemic attack (TIA); cardiac surgical procedures; neuroprotection; β-adrenergic blockers; coronary artery bypass graft (CABG) surgery; β-adrenergic receptor (βAR); stroke; coma; neurologic complications; Human; Nervous system diseases; Treatment efficiency; Neuroprotective agent; Incidence; β-Adrenergic receptor; Prevention; Chemotherapy; Treatment; Aortocoronary; Bypass; Surgery; Complication; Graft; Antagonist; Comparative study; Beta blocking agent
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/jcan.2002.124132

Objective: To determine the impact of perioperative β-adrenergic receptor (βAR) antagonist administration on neurologic complications. Design: Observational database analysis. Setting: A clinical investigation at a single tertiary academic medical center. Participants: Elective coronary artery bypass graft surgical patients operated on in the period 1994-1996. Interventions: Patients were divided into 2 groups: (1) patients given βAR antagonist–blocking drugs in the perioperative period, including during operation, and (2) patients not given βAR antagonists. Measurements and Main Results: βAR antagonist use in 2,575 consecutive patients undergoing coronary artery bypass graft surgery (1994-1996) was determined using the Cardiovascular Database and Anesthesia Information System Database. Outcome variables were postoperative stroke, coma, and transient ischemic attack. Of patients, 113 (4.4%) had postoperative neurologic complications, including stroke (n = 44), coma (n = 12), and transient ischemic attack (n = 3). Of patients, 2,296 (89%) received perioperative βAR antagonist therapy, and 279 (11%) did not. Adverse neurologic events occurred in 3.9% (n = 90) of patients who received perioperative βAR antagonists and 8.2% (n = 23) of patients who did not receive βAR antagonists (odds ratio, 0.45; 95% confidence interval, 0.28 to 0.73; p = 0.003, unadjusted.) Severe neurologic outcomes (stroke and coma) occurred in 1.9% (n = 44) of patients who received βAR antagonists and 4.3% (n = 12) of patients who did not receive βAR antagonists (odds ratio, 0.43; 95% confidence interval, 0.23 to 0.83; p = 0.016). Conclusion: Use of β-adrenergic antagonists was associated with a substantial reduction in the incidence of postoperative neurologic complications. A prospective randomized trial is needed to verify this potentially important neuroprotective strategy in cardiac surgery. Copyright 2002, Elsevier Science (USA). All rights reserved.