Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric

Area of Science:

• Cardiology
• Cardiac Surgery
• Clinical Quality Metrics

Background:

• Preoperative beta-blocker use is a standard quality metric for coronary artery bypass graft (CABG) surgery.
• Recent studies challenge the effectiveness of this metric, prompting further investigation.

Purpose of the Study:

• To evaluate the impact of preoperative beta-blocker administration on outcomes in patients undergoing CABG with left ventricular dysfunction.

Main Methods:

• Analysis of isolated CABG cases (n=6116) with ejection fraction <50% from the China Heart Failure Surgery Registry (2012-2017).
• Utilized multivariate regression and 1-1 propensity score matching.
• Compared outcomes between patients who received preoperative beta-blockers and those who did not.

Main Results:

• No significant difference in operative mortality between groups (3.7% vs. 3.0%).
• Preoperative beta-blocker use was associated with a reduced incidence of postoperative stroke (0.7% vs. 0.3%).
• Propensity-matched analyses confirmed these findings.

Conclusions:

• Preoperative beta-blockers before CABG in patients with left ventricular dysfunction do not improve operative mortality or most complications.
• Beta-blocker administration may reduce the risk of postoperative stroke.
• Development of more specific quality metrics for beta-blocker use is recommended.