The impact of acute preoperative beta-blockade on perioperative cardiac morbidity and all-cause mortality in hypertensive South African vascular surgery patients
South African Medical Journal
Perioperative Research Group, Department of Anaesthetics, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Background. Acute β-blockade has been associated with poor perioperative outcomes in non-cardiac surgery patients, probably as a result of β-blocker-induced haemodynamic instability during the perioperative period, which has been shown to be more severe in hypertensive patients. Objective. To determine the impact of acute preoperative β-blockade on the incidence of perioperative cardiovascular morbidity and allcause mortality in hypertensive South African (SA) patients who underwent vascular surgery at a tertiary hospital. Methods. We conducted two separate case-control analyses to determine the impact of acute preoperative β-blockade on the incidence of major adverse cardiovascular events (MACEs, a composite outcome of a perioperative troponin-I leak or all-cause mortality) and perioperative troponin-I leak alone. Case and control groups were compared using χ2, Fisher’s exact, McNemar’s or Student’s t-tests, where applicable. Binary logistic regression was used to determine whether acute preoperative β-blocker use was an independent predictor of perioperative MACEs/troponin-I leak in hypertensive SA vascular surgery patients. Results. We found acute preoperative β-blockade to be an independent predictor of perioperative MACEs (odds ratio (OR) 3.496; 95% confidence interval (CI) 1.948 - 6.273; p<0.001) and troponin-I leak (OR 5.962; 95% CI 3.085 - 11.52; p<0.001) in hypertensive SA vascular surgery patients. Conclusions. Our findings suggest that acute preoperative β-blockade is associated with an increased risk of perioperative cardiac morbidity and all-cause mortality in hypertensive SA vascular surgery patients. © 2015, South African Medical Journal. All right reserved.
atenolol; carvedilol; labetalol; troponin I; adult; Article; beta adrenergic receptor blocking; cardiovascular disease; cardiovascular mortality; case control study; controlled study; female; human; hypertension; incidence; major clinical study; male; outcome assessment; perioperative period; preoperative period; scoring system; vascular surgery
D43TW000231, NIH, National Institutes of Health