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Published on: March 27, 2018
Rationale for administering beta-blocker therapy to patients undergoing coronary artery bypass surgery: a systematic
Arushi Thaper1, Alexander Kulik1
1a Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA.
Insights
Beta-blockers are recommended for patients undergoing coronary artery bypass graft (CABG) surgery, especially those with prior myocardial infarction or congestive heart failure. Perioperative use of beta-blockers, particularly carvedilol, reduces mortality and new-onset atrial fibrillation post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Secondary prevention is crucial for optimizing outcomes in coronary artery bypass graft (CABG) patients.
- The role of beta-blockers in CABG patients requires clarification despite their established benefits in coronary artery disease and congestive heart failure (CHF).
Purpose of the Study:
- To evaluate the rationale for beta-blocker administration in the CABG population.
- To assess the efficacy of beta-blockers before and after coronary surgical revascularization.
Main Methods:
- A systematic literature review was conducted.
- Relevant articles were retrieved from the PubMed database.
- The search spanned publications from 1985 to 2017.
Main Results:
- Beta-blockers are strongly supported for patients with previous myocardial infarction (MI) or CHF.
- Perioperative beta-blocker therapy in CABG patients is associated with reduced mortality, especially in those with prior MI or CHF.
- Beta-blocker use significantly lowers the incidence of new-onset postoperative atrial fibrillation after CABG.
- Perioperative carvedilol demonstrated the most benefit among evaluated beta-blockers.
Conclusions:
- Nearly all CABG patients without contraindications are candidates for perioperative beta-blocker therapy.
- Beta-blockers are essential for secondary prevention in CABG patients, improving both perioperative and long-term outcomes.
Introduction:
Secondary preventative therapies are essential for patients undergoing coronary artery bypass graft (CABG) surgery to optimize perioperative and long-term outcomes. Beta-blockers are commonly used to treat patients with coronary artery disease and congestive heart failure (CHF), but their role for CABG patients remains unclear. The goal of this systematic review was to evaluate the rationale for administering beta-blockers to the CABG population and to assess their efficacy before and after coronary surgical revascularization.
Areas Covered:
A systematic literature review was performed to retrieve relevant articles from the PubMed database published between 1985 and 2017.
Expert Opinion:
Outside of the surgical field, strong evidence supports the use of beta-blockers for patients with a history of previous myocardial infarction (MI) or CHF. For the CABG population, studies have suggested that perioperative beta-blocker therapy is beneficial, with an associated reduction in mortality, particularly among those with a history of previous MI or CHF. Beta-blocker administration has also clearly been shown to lower the rate of new-onset postoperative atrial fibrillation after CABG. Among the different types of beta-blockers, perioperative carvedilol appears to be the most beneficial. In the absence of contraindications, nearly all CABG patients are candidates for perioperative beta-blocker therapy.
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