Keeley H Stone1,2, Katie Reynolds1, Sondra Davis1, Benjamin W Van Tassell3, Caitlin M Gibson4,5. 1. Medical City Arlington, 3301 Matlock Road, Arlington, TX, 76015, USA. 2. Texas Health Harris Methodist Hospital, 1301 Pennsylvania Ave, Fort Worth, TX, 76104, USA. 3. Virginia Commonwealth University School of Pharmacy, 410 N. 12th Street, Richmond, VA, 23298, USA. 4. Medical City Arlington, 3301 Matlock Road, Arlington, TX, 76015, USA. GibsonCM3@vcu.edu. 5. Virginia Commonwealth University School of Pharmacy, 410 N. 12th Street, Richmond, VA, 23298, USA. GibsonCM3@vcu.edu.
Abstract
OBJECTIVE: Post-operative atrial fibrillation (POAF) is a common complication of coronary artery bypass graft (CABG) surgery. Previous studies suggest carvedilol is more effective than metoprolol in preventing POAF in on-pump CABG. This study investigated if the same benefit would be seen in off-pump CABG. METHODS: This single-center, retrospective review compared rates of new-onset POAF between adult patients who received carvedilol and metoprolol after off-pump CABG surgery. Safety endpoints included hypotension, bradycardia, dyspnea, and the composite. Multivariate logistic regression was conducted to identify associations between demographics, potential confounders, and beta-blocker dose and POAF. Kaplan-Meier plots and Cox proportional-hazards models examined differences in time-to-event for POAF. RESULTS: 134 patients were included (34 carvedilol and 100 metoprolol). The mean age was 63 years, 70.9% were male, 85% had history of hypertension, 3.7% had history of heart failure with reduced ejection fraction, and 38.8% were taking beta blockers prior to admission. POAF developed in 2 patients (5.8%) in the carvedilol group and 24 patients (24.0%) in the metoprolol group (odds ratio 0.17 [95% CI 0.03-0.83], p = 0.023). Safety endpoints occurred in 10 carvedilol (29.4%) and 44 metoprolol (44.0%) patients (p = 0.134). Hypotension and dyspnea rates were similar between groups; bradycardia occurred more commonly among metoprolol-treated patients (p = 0.040). Time-to-event analyses revealed a hazard ratio = 0.22 (95% CI 0.05-0.93, p = 0.040) for carvedilol use. CONCLUSIONS: In this single-center, retrospective study of off-pump CABG patients, carvedilol was associated with reduced POAF risk and enhanced safety compared to metoprolol.
OBJECTIVE: Post-operative atrial fibrillation (POAF) is a common complication of coronary artery bypass graft (CABG) surgery. Previous studies suggest carvedilol is more effective than metoprolol in preventing POAF in on-pump CABG. This study investigated if the same benefit would be seen in off-pump CABG. METHODS: This single-center, retrospective review compared rates of new-onset POAF between adult patients who received carvedilol and metoprolol after off-pump CABG surgery. Safety endpoints included hypotension, bradycardia, dyspnea, and the composite. Multivariate logistic regression was conducted to identify associations between demographics, potential confounders, and beta-blocker dose and POAF. Kaplan-Meier plots and Cox proportional-hazards models examined differences in time-to-event for POAF. RESULTS: 134 patients were included (34 carvedilol and 100 metoprolol). The mean age was 63 years, 70.9% were male, 85% had history of hypertension, 3.7% had history of heart failure with reduced ejection fraction, and 38.8% were taking beta blockers prior to admission. POAF developed in 2 patients (5.8%) in the carvedilol group and 24 patients (24.0%) in the metoprolol group (odds ratio 0.17 [95% CI 0.03-0.83], p = 0.023). Safety endpoints occurred in 10 carvedilol (29.4%) and 44 metoprolol (44.0%) patients (p = 0.134). Hypotension and dyspnea rates were similar between groups; bradycardia occurred more commonly among metoprolol-treated patients (p = 0.040). Time-to-event analyses revealed a hazard ratio = 0.22 (95% CI 0.05-0.93, p = 0.040) for carvedilol use. CONCLUSIONS: In this single-center, retrospective study of off-pump CABG patients, carvedilol was associated with reduced POAF risk and enhanced safety compared to metoprolol.
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