Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2014 Feb;30(2):217-23. doi: 10.1016/j.cjca.2013.10.011. Epub 2013 Oct 24.
Although practice guidelines recommend that perioperative β-blockade be initiated at least several days to weeks before noncardiac surgery is performed, the minimum required period of preoperative therapy is unclear.
Population-based administrative databases were used to conduct a cohort study of 48,103 patients aged ≥ 66 years who underwent major elective noncardiac surgery in Ontario, Canada and received preoperative β-blocker therapy. We used multivariable logistic regression to determine the association of duration of preoperative β-blocker treatment (classified as 1-7 days, 8-30 days, and ≥ 31 days) with 30-day mortality, 30-day myocardial infarction (MI), 30-day ischemic stroke, and 1-year mortality.
The duration of preoperative β-blocker treatment was 1-7 days in 1105 patients (2.3%), 8-30 days in 2639 patients (5.5%), and ≥ 31 days in 44,269 patients (92.0%). Compared with ≥ 31 days of preoperative therapy, 1-7 days of therapy was associated with increased 30-day mortality (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.03-2.16; P = 0.03], whereas 8-30 days of therapy was not (OR, 0.95; 95% CI, 0.69-1.31; P = 0.77). One to 7 days of preoperative therapy was not significantly associated with 1-year mortality (OR, 1.06; 95% CI, 0.84-1.35; P = 0.62), 30-day MI (OR, 1.26; 95% CI, 0.92-1.71; P = 0.15), or 30-day ischemic stroke (OR, 1.37; 95% CI, 0.64-2.94; P = 0.41).
Initiation of β-blocker therapy 1-7 days before noncardiac surgery is associated with increased 30-day mortality. The findings merit further evaluation by randomized trials.
尽管实践指南建议在非心脏手术前至少数天至数周开始围手术期β受体阻滞剂治疗，但术前治疗所需的最短时间尚不清楚。
使用基于人群的行政数据库，对在加拿大安大略省接受择期非心脏大手术且接受术前β受体阻滞剂治疗的 48103 名年龄≥66 岁的患者进行了队列研究。我们使用多变量逻辑回归来确定术前β受体阻滞剂治疗时间（分为 1-7 天、8-30 天和≥31 天）与 30 天死亡率、30 天心肌梗死（MI）、30 天缺血性卒中和 1 年死亡率之间的关系。
1105 例（2.3%）患者的术前β受体阻滞剂治疗时间为 1-7 天，2639 例（5.5%）患者为 8-30 天，44269 例（92.0%）患者为≥31 天。与≥31 天的治疗相比，1-7 天的治疗与 30 天死亡率增加相关（比值比 [OR]，1.49；95%置信区间 [CI]，1.03-2.16；P=0.03），而 8-30 天的治疗无此相关性（OR，0.95；95%CI，0.69-1.31；P=0.77）。术前 1-7 天的治疗与 1 年死亡率（OR，1.06；95%CI，0.84-1.35；P=0.62）、30 天 MI（OR，1.26；95%CI，0.92-1.71；P=0.15）或 30 天缺血性卒中等（OR，1.37；95%CI，0.64-2.94；P=0.41）无显著相关性。
在非心脏手术前 1-7 天开始β受体阻滞剂治疗与 30 天死亡率增加相关。这些发现值得通过随机试验进一步评估。
