Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: A nationwide cohort study

Mads E. Jørgensen; Robert D. Sanders; Lars Køber; Kala Mehta; Christian Torp-Pedersen; Mark A. Hlatky; Jannik L. Pallisgaard; Richard E. Shaw; Gunnar H. Gislason; Per F. Jensen; Charlotte Andersson

doi:10.1093/eurheartj/ehx214

Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: A nationwide cohort study

Mads E. Jørgensen^*, Robert D. Sanders, Lars Køber, Kala Mehta, Christian Torp-Pedersen, Mark A. Hlatky, Jannik L. Pallisgaard, Richard E. Shaw, Gunnar H. Gislason, Per F. Jensen, Charlotte Andersson

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin

13 Citationer (Scopus)

Abstract

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.

Originalsprog	Engelsk
Tidsskrift	European Heart Journal
Vol/bind	38
Udgave nummer	31
Sider (fra-til)	2421-2428
ISSN	0195-668X
DOI	https://doi.org/10.1093/eurheartj/ehx214
Status	Udgivet - 2017

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10.1093/eurheartj/ehx214

ehx214.pdfForlagets udgivne version, 272 KB

https://academic.oup.com/eurheartj/article-pdf/38/31/2421/21528326/ehx214.pdf

Citationsformater

Jørgensen, M. E., Sanders, R. D., Køber, L., Mehta, K., Torp-Pedersen, C., Hlatky, M. A., Pallisgaard, J. L., Shaw, R. E., Gislason, G. H., Jensen, P. F., & Andersson, C. (2017). Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: A nationwide cohort study. European Heart Journal, 38(31), 2421-2428. https://doi.org/10.1093/eurheartj/ehx214

Jørgensen, ME, Sanders, RD, Køber, L, Mehta, K, Torp-Pedersen, C, Hlatky, MA, Pallisgaard, JL, Shaw, RE, Gislason, GH, Jensen, PF & Andersson, C 2017, 'Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: A nationwide cohort study', European Heart Journal, bind 38, nr. 31, s. 2421-2428. https://doi.org/10.1093/eurheartj/ehx214

@article{c0023837f0cc4ded9bc93f88b7223ac9,

title = "Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: A nationwide cohort study",

abstract = "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.",

keywords = "Beta-blocker, Outcomes, Perioperative risks, Safety, Surgery",

author = "J{\o}rgensen, {Mads E.} and Sanders, {Robert D.} and Lars K{\o}ber and Kala Mehta and Christian Torp-Pedersen and Hlatky, {Mark A.} and Pallisgaard, {Jannik L.} and Shaw, {Richard E.} and Gislason, {Gunnar H.} and Jensen, {Per F.} and Charlotte Andersson",

year = "2017",

doi = "10.1093/eurheartj/ehx214",

language = "English",

volume = "38",

pages = "2421--2428",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "31",

}

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

SN - 0195-668X

VL - 38

SP - 2421

EP - 2428

JO - European Heart Journal

JF - European Heart Journal

IS - 31

ER -

Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: A nationwide cohort study

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