Effect of β-blocker Prescription on the Incidence of Postoperative Myocardial Infarction after Hip and Knee Arthroplasty

• Published in: Anesthesiology (Philadelphia) 2009-10, Vol.111 (4), p.717-724
• Main Authors: VAN KLEI, Wilton A, BRYSON, Gregory L, YANG, Homer, FORSTER, Alan J
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Age Factors; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biological and medical sciences; Cohort Studies; Data Interpretation, Statistical; Female; Hemoglobins - metabolism; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Medical sciences; Middle Aged; Myocardial Infarction - chemically induced; Myocardial Infarction - epidemiology; Myocardial Infarction - mortality; Perioperative Care; Postoperative Complications - chemically induced; Postoperative Complications - epidemiology; Postoperative Complications - mortality; Risk Assessment; Survival Analysis; Treatment Outcome; United States - epidemiology
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0b013e3181b6a761

American College of Cardiology/American Heart Association guidelines recommend beta-blockade for selected low- and intermediate-risk noncardiac surgery patients. The authors evaluated the effect of perioperative beta-blockade on postoperative myocardial infarction (POMI) in low-risk patients undergoing intermediate-risk surgery. Patients who underwent elective hip or knee arthroplasty between January 1, 2002 and June 30, 2006 were identified. POMI was defined as a Troponin T value of more than 0.1 ng . ml(-1). Patients were divided into three groups: those prescribed a beta-blocker on the day of surgery and throughout their hospital stay (or 7 days, whichever came first), those prescribed a beta-blocker on the day of surgery but discontinued during the first 7 days, and those not prescribed a beta-blocker on the day of surgery. Propensity analysis and logistic regression were used to determine the independent association of beta-blocker exposure on POMI. Of the 5,158 arthroplasty patients, 992 (18%) were treated with beta-blockers on the day of surgery. This beta-blocker was discontinued in 252 patients (25%). POMI occurred in 77 patients (1.5%). Discontinuation of beta-blocker prescription was significantly associated with POMI (odds ratio 2.0; 95% CI 1.1-3.9) and death (odds ratio 2.0; 95% CI 1.0-3.9). After adjustment for confounders, discontinuation of beta-blocker prescription during the first week after surgery was significantly associated with POMI and death. These findings confirm the American College of Cardiology/American Heart Association Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery, which recommend not to withdraw beta-blocker therapy.