Department of Cardiology, The Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
Eur Heart J. 2017 Aug 14;38(31):2421-2428. doi: 10.1093/eurheartj/ehx214.
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.
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).
Risks of ACM and MACE did not systematically differ by beta-blocker subtype. Findings may guide clinical practice and future trials.
β受体阻滞剂在药效动力学和药代动力学特性上存在差异。目前尚不清楚特定类型的β受体阻滞剂是否与围手术期风险增加相关。我们评估了β受体阻滞剂亚类与围手术期风险的关系，包括整体和患者亚组。
我们进行了一项丹麦全国队列研究，纳入了 2005 年至 2011 年期间在非心脏手术前长期接受β受体阻滞剂（阿替洛尔、比索洛尔、卡维地洛、美托洛尔、普萘洛尔或其他）治疗的患者。使用调整后的逻辑回归模型和比值比（95%置信区间）来评估 30 天全因死亡率（ACM）和 30 天主要不良心血管事件（MACE）的风险。我们共确定了 61660 名患者，其中最常使用美托洛尔（67%的患者，平均年龄 69 岁，49%为男性）、阿替洛尔（10%的患者，平均年龄 68 岁，36%为男性）或卡维地洛（9%的患者，平均年龄 68 岁，60%为男性）。美托洛尔组的 ACM 和 MACE 的粗发生率分别为 4.1%和 3.5%，阿替洛尔组分别为 3.0%和 2.3%，卡维地洛组分别为 4.8%和 4.6%。在调整后的模型中，阿替洛尔（ACM：1.10[0.92-1.32]，MACE：1.08[0.90-1.31]）或卡维地洛（ACM：0.99[0.85-1.16]，MACE：1.07[0.92-1.25]）的风险与美托洛尔相比并无显著差异。与美托洛尔相比，有心肌梗死史的患者使用卡维地洛的 ACM 风险显著降低（0.62[0.43-0.87]），无合并高血压的患者的 MACE 风险无差异（1.41[0.83-2.40]）。按年龄、手术优先级、麻醉时间或手术风险分层分析，风险无差异（所有交互作用 P 值均>0.05）。
β受体阻滞剂亚类的 ACM 和 MACE 风险无系统差异。研究结果可为临床实践和未来的试验提供指导。
