AI Article Synopsis
- The study examined how keeping patients on beta-blockers during cardiac surgery impacts rates of atrial fibrillation and acute kidney injury (AKI).
- Results showed no significant reduction in atrial fibrillation risk with beta-blocker maintenance, although it was linked to higher use of norepinephrine and increased AKI rates post-surgery.
- Overall, maintaining beta-blockers did not prevent postoperative atrial fibrillation and may have led to adverse kidney effects due to increased vasopressor use.
Article Abstract
Background: We investigated the effects of maintaining beta-blockers on the day of surgery on the incidence of atrial fibrillation and postoperative acute kidney injury (AKI) in patients undergoing cardiac surgery.
Methods: We conducted a multicentre prospective observational study with propensity matching on patients treated with beta-blockers. We collected their baseline patient characteristics, comorbidities, and operative and postoperative outcomes. The endpoints were postoperative atrial fibrillation and AKI after cardiac surgery.
Results: Of the 1789 included patients, propensity matching led to 583 patients in each group. Maintenance of beta-blockers was not associated with a reduced risk of atrial fibrillation (odds ratio: 0.86 [95% confidence interval 0.66-1.14], P=0.335; 141 patients [24.2%] vs 126 patients [21.6%]). Sensitivity analysis did not demonstrate association between beta-blocker maintenance and atrial fibrillation after cardiac surgery (odds ratio: 0.93 [95% confidence interval: 0.72-1.22], P=0.625). Maintenance of beta-blockers was associated with a higher rate of norepinephrine use (415 [71.2%] vs 465 [79.8%], P=0.0001) and postoperative AKI (124 [21.3%] vs 159 [27.3%], P=0.0127). No statistically significant difference was observed in ICU length of stay.
Conclusions: Maintenance of beta-blockers on the day of surgery was not associated with a reduced incidence of postoperative atrial fibrillation. However, maintenance of beta-blockers was associated with increased usage of vasopressors, potentially contributing to adverse postoperative renal events.
Clinical Trial Registration: NCT04769752.
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| http://dx.doi.org/10.1016/j.bja.2024.04.018 | DOI Listing |
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