* Cardiac Anesthesia Fellow, Department of Anesthesia, University Health Network, Toronto, Ontario, Canada. † Cardiac Anesthesia Fellow, Department of Anesthesia, St. Michaels Hospital and the University of Toronto, Toronto, Ontario, Canada. ‡ Assistant Professor, Department of Anesthesia, University Health Network; Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy Management and Evaluation; and University of Toronto. § Assistant Professor, Department of Anesthesia, University Health Network, and University of Toronto. ‖ Professor, Department of Anesthesia, St. Michaels Hospital and the University of Toronto, and Li Ka Shing Knowledge Institute of St. Michael's Hospital. # Associate Professor, Department of Anesthesia, St. Michaels Hospital and the University of Toronto, and Li Ka Shing Knowledge Institute of St. Michael's Hospital. ** Professor, Department of Anesthesia, University Health Network; The Peter Munk Cardiac Centre (within Toronto General Hospital), Toronto, Ontario, Canada; and University of Toronto.
Anesthesiology. 2013 Oct;119(4):777-87. doi: 10.1097/ALN.0b013e3182a17f12.
Perioperative metoprolol increases postoperative stroke. Animal studies indicate that the mechanism may be related to attenuated β(2)-adrenoreceptor-mediated cerebral vasodilatation. The authors therefore conducted a cohort to study whether the highly β(1)-specific β-blocker (bisoprolol) was associated with a reduced risk of postoperative stroke compared with less selective β-blockers (metoprolol or atenolol).
The authors conducted a single-center study on 44,092 consecutive patients with age 50 yr or more having noncardiac, nonneurologic surgery. The primary outcome was stroke within 7 days of surgery. The secondary outcome was a composite of all-cause mortality, postoperative myocardial injury, and stroke. A propensity score-matched cohort was created to assess the independent association between bisoprolol and less β(1)-selective agents metoprolol or atenolol. A secondary analysis using logistic regression, based on previously identified confounders, also compared selective β(1)-antagonism.
Twenty-four percent (10,756) of patients were exposed to in-hospital β-blockers. A total of 88 patients (0.2%) suffered a stroke within 7 days of surgery. The matched cohort consisted of 2,462 patients, and the pairs were well matched for all variables. Bisoprolol was associated with fewer postoperative strokes than the less selective agents (odds ratio = 0.20; 95% CI, 0.04-0.91). Multivariable risk-adjustment in the β-blockers-exposed patients comparing bisoprolol with the less selective agents was associated with a similarly reduced stroke rate.
The use of metoprolol and atenolol is associated with increased risks of postoperative stroke, compared with bisoprolol. These findings warrant confirmation in a pragmatic randomized trial.
围手术期使用美托洛尔会增加术后中风的风险。动物研究表明，其机制可能与减弱β(2)-肾上腺素能受体介导的脑血管舒张有关。因此，作者进行了一项队列研究，以研究高度β(1)-选择性β受体阻滞剂（比索洛尔）是否与术后中风风险降低相关，与选择β(1)-受体阻滞剂（美托洛尔或阿替洛尔）相比。
作者对 44092 例年龄在 50 岁及以上的非心脏、非神经外科手术患者进行了一项单中心研究。主要结局是术后 7 天内发生中风。次要结局是全因死亡率、术后心肌损伤和中风的复合结局。创建了倾向评分匹配队列，以评估比索洛尔与选择β(1)-受体阻滞剂（美托洛尔或阿替洛尔）之间的独立关联。基于先前确定的混杂因素，还使用逻辑回归进行了二次分析，比较了选择性β(1)-拮抗剂。
24%（10756 例）的患者在住院期间接受了β受体阻滞剂治疗。共有 88 例患者（0.2%）在手术后 7 天内发生中风。匹配队列由 2462 例患者组成，两组在所有变量上均匹配良好。与选择β(1)-受体阻滞剂（美托洛尔或阿替洛尔）相比，比索洛尔与术后中风的发生风险较低相关（比值比=0.20；95%CI，0.04-0.91）。在接受β受体阻滞剂治疗的患者中，对多变量风险因素进行调整，比较比索洛尔与选择β(1)-受体阻滞剂，结果显示中风发生率也降低。
与比索洛尔相比，使用美托洛尔和阿替洛尔与术后中风风险增加相关。这些发现需要在一项实用的随机试验中得到证实。
