Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: A nationwide cohort study
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery : A nationwide cohort study. / Jørgensen, Mads E.; Sanders, Robert D.; Køber, Lars; Mehta, Kala; Torp-Pedersen, Christian; Hlatky, Mark A.; Pallisgaard, Jannik L.; Shaw, Richard E.; Gislason, Gunnar H.; Jensen, Per F.; Andersson, Charlotte.
I: European Heart Journal, Bind 38, Nr. 31, 2017, s. 2421-2428.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery
T2 - A nationwide cohort study
AU - Jørgensen, Mads E.
AU - Sanders, Robert D.
AU - Køber, Lars
AU - Mehta, Kala
AU - Torp-Pedersen, Christian
AU - Hlatky, Mark A.
AU - Pallisgaard, Jannik L.
AU - Shaw, Richard E.
AU - Gislason, Gunnar H.
AU - Jensen, Per F.
AU - Andersson, Charlotte
PY - 2017
Y1 - 2017
N2 - 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 and results 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.
AB - 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 and results 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.
KW - Beta-blocker
KW - Outcomes
KW - Perioperative risks
KW - Safety
KW - Surgery
U2 - 10.1093/eurheartj/ehx214
DO - 10.1093/eurheartj/ehx214
M3 - Journal article
C2 - 28472245
AN - SCOPUS:85032724302
VL - 38
SP - 2421
EP - 2428
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 31
ER -
ID: 189462840