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CARDIOVASCULAR ANESTHESIA

Drug Therapy Before Coronary Artery Surgery: Nitrates Are Independent Predictors of Mortality and ß-Adrenergic Blockers Predict Survival

William M. Weightman, MBChB, FANZCA^*, Neville M. Gibbs, MBBS, FANZCA, MD^*, Matthew R. Sheminant, RN, CCP^*, Eric G. Whitford, MBBS, FRACP, Barry D. Mahon, BSc(Hons), MB ChB, FCS(SA), and Mark A. J. Newman, MB, BS (Hons), FRACS, MD

Departments of *Anaesthesia, Cardiovascular Medicine, and Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia

Address correspondence and reprint requests to W. M. Weightman, Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009.

We conducted this study to evaluate whether there is an association between preoperative drug therapy and in-hospital mortality in patients undergoing coronary artery graft surgery. We collected data on 1593 consecutive patients undergoing coronary artery surgery. The relative risk of in-hospital mortality was determined by logistic regression with in-hospital mortality as the dependent variable, and independent variables that included known risk factors and preoperative cardioactive or antithrombotic drug treatment, i.e., age; left ventricular function; left main coronary artery disease; urgent priority; gender; previous cardiac surgery; concurrent cardiovascular surgery; chronic lung disease; creatinine concentration; hemoglobin concentration; diabetes; hypertension; cerebrovascular disease; recent myocardial infarction; prior vascular surgery; number of arteries bypassed; and regular daily treatment with ß-blockers, aspirin within 5 days, calcium antagonists, angiotensin converting enzyme (ACE) inhibitors, digoxin, or warfarin. In-hospital mortality was 3.3%. The relative risk of in-hospital mortality (with 95% confidence intervals of the relative risk) associated with the following drug treatments was: nitrates 3.8 (1.5–9.6), ß-blockers 0.4 (0.2–0.8), aspirin within 5 days 1.0 (0.5–1.9), calcium antagonists 1.1 (0.6–2.1), ACE inhibitors 0.8 (0.4–1.5), digoxin 0.7 (0.2–1.8), and warfarin 0.3 (0.1–1.6). We conclude that in-hospital mortality is positively associated with preoperative nitrate therapy and negatively associated with ß-adrenergic blocker therapy. A significant association between in-hospital mortality and the preoperative use of calcium antagonists, ACE inhibitors, aspirin, digoxin, and warfarin was not confirmed.

Implications: We examined the association between common drug treatments for ischemic heart disease and short-term survival after cardiac surgery using a statistical method to adjust for patients' preoperative medical condition. Death after surgery was more likely after nitrate therapy and less likely after ß-blocker therapy.

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