Department of Vascular Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA.
Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA.
Ann Vasc Surg. 2022 Mar;80:170-179. doi: 10.1016/j.avsg.2021.07.056. Epub 2021 Oct 14.
Beta-blockers have become the cornerstone for medical management in patients with chronic type B aortic dissection (TBAD). However, the effect of being on and/or receiving intravenous beta-blockers during hospitalization on outcomes of surgical repair of TBAD is not fully described. We sought to investigate this association during open surgical repair (OSR) and endovascular (Endo) intervention for nontraumatic TBAD.
The Premier Healthcare Database was inquired (June/2009-March/2015). Patients with nontraumatic isolated TBAD were identified via ICD-9-CM diagnosis and procedural codes. Patients with codes that indicated TAAD were excluded. In-hospital mortality, cardiac complications (CHF, MI, arrythmia) and stroke were evaluated. Log binomial regression analyses with bootstrapping were performed to assess the relative risk of adverse outcomes.
A total of 1,752 were admitted for OSR (54.3%) and Endo (45.7%) TBAD repair. Use of oral beta blocker (BB) was 16.0% in OSR and 56.4% in Endo groups. In each arm, patients on BB were more likely to be diabetic, on aspirin or statin and more likely to receive additional IV BB than nonBB patients. There was no significant difference in age, sex, race, or prior history of CHF between BB and nonBB groups. Mortality was proportionally lower in patients on BB in OSR group (7.9% vs. 16.7%; P = 0.006) and Endo (3.3% vs. 9.2%; P < 0.001). The adjusted relative risk for mortality and stroke were significantly lower in oral BB recipients compared with none [aRR (95% CI): 0.53 (0.32-0.90) and 0.46 (0.25-0.87); both P ≤ 0.02]. IV metoprolol was the only IV BB that reduced mortality [aRR (95% CI): 0.62 (0.46-0.85); P = 0.003]. A dose of ≤10 mg was associated with significant mortality reduction: 6.3% (3.0-9.5%) compared with 8.1% (4.6-11.6%) in no IV BB group. Cardiac complications were not affected by BB use.
For patients with nontraumatic TBAD, use of oral BB was associated with significant protection against in-hospital mortality and stroke following repair. Metoprolol was the only Intravenous BB type associated with improved survival. Further research is warranted to elucidate the effect of beta-blockers on the long-term surgical outcomes of TBAD.
β受体阻滞剂已成为慢性 B 型主动脉夹层（TBAD）患者医学治疗的基石。然而，在住院期间使用β受体阻滞剂（静脉内或口服）对 TBAD 手术修复结局的影响尚未完全描述。我们旨在研究其与开放性外科修复（OSR）和血管内（Endo）干预治疗非外伤性 TBAD 的相关性。
查询 Premier Healthcare Database（2009 年 6 月至 2015 年 3 月）。通过 ICD-9-CM 诊断和程序代码识别非外伤性孤立性 TBAD 患者。排除有胸主动脉夹层（TAAD）代码的患者。评估院内死亡率、心脏并发症（心力衰竭、心肌梗死、心律失常）和中风。使用带引导的对数二项式回归分析评估不良结局的相对风险。
共有 1752 例患者接受 OSR（54.3%）和 Endo（45.7%）TBAD 修复。OSR 和 Endo 组中分别有 16.0%和 56.4%的患者使用口服β受体阻滞剂（BB）。在每个组中，使用 BB 的患者更可能患有糖尿病，更可能服用阿司匹林或他汀类药物，并且比未使用 BB 的患者更可能接受额外的静脉内 BB。BB 和非 BB 组之间在年龄、性别、种族或心力衰竭既往史方面无显著差异。在 OSR 组中，使用 BB 的患者死亡率呈比例降低（7.9%比 16.7%；P=0.006），Endo 组中（3.3%比 9.2%；P<0.001）。与未使用 BB 的患者相比，口服 BB 组的死亡率和中风的调整后相对风险显著降低[比值比（95%置信区间）：0.53（0.32-0.90）和 0.46（0.25-0.87）；均 P≤0.02]。静脉注射美托洛尔是唯一降低死亡率的静脉内 BB[aRR（95%CI）：0.62（0.46-0.85）；P=0.003]。剂量≤10mg 与显著降低死亡率相关：6.3%（3.0-9.5%），而非静脉内 BB 组为 8.1%（4.6-11.6%）。BB 的使用不影响心脏并发症。
对于非外伤性 TBAD 患者，使用口服 BB 与修复后院内死亡率和中风的显著降低相关。美托洛尔是唯一与改善生存率相关的静脉内 BB 类型。需要进一步研究阐明β受体阻滞剂对 TBAD 长期手术结局的影响。
