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CARDIOVASCULAR ANESTHESIA

The Association Between Heart Rate and In-Hospital Mortality After Coronary Artery Bypass Graft Surgery

Mary P. Fillinger, MD^*, Stephen D. Surgenor, MD MS^*, Gregg S. Hartman, MD^*, Cantwell Clark, MD^¶, Thomas M. Dodds, MD^*, Athos J. Rassias, MD^*, William C. Paganelli, MD^**, Peter Marshall, MD^#, David Johnson, MD^¶, Dennis Kelly, MD, Dean Galatis, MD, Elaine M. Olmstead, BA, Cathy S. Ross, MS^&Verbar||, and Gerald T. O’Connor, PhD DSc^|||| for the Northern New England Cardiovascular Disease Study Group

Departments of *Anesthesiology and Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Department of Anesthesiology, Catholic Medical Center, Manchester, New Hampshire; Department of Anesthesiology, Concord Hospital, Concord, New Hampshire; &Verbar||Dartmouth Medical School, Hanover, New Hampshire; ¶Department of Anesthesiology, Maine Medical Center, Portland, Maine; #Department of Anesthesiology, Central Maine Medical Center, Lewiston, Maine; and **Department of Anesthesiology, Fletcher Allen Health Care, Burlington, Vermont

Address correspondence and reprint requests to Mary P. Fillinger, MD, Department of Anesthesiology, One Medical Center Drive, Lebanon, NH 03756. Address e-mail to mary.p.fillinger{at}hitchcock.org

Avoidance of tachycardia is a commonly described goal for anesthetic management during coronary artery bypass graft (CABG) surgery. However, an association between increased intraoperative heart rate and mortality has not been described. We conducted an observational study to evaluate the association between preinduction heart rate (heart rate upon arrival to the operating room) and in-hospital mortality during CABG surgery. Data were collected on 5934 CABG patients. Fifteen percent of patients had an increased preinduction heart rate 80 bpm. Crude mortality was significantly more frequent among patients with increased preinduction heart rate (P_trend = 0.002). After adjustment for baseline differences among patients, preinduction heart rate 80 bpm remained associated with increased mortality (P_trend < 0.001). The increased heart rate may be a cause of the observed mortality. Alternatively, faster heart rate may be either a marker of patients with irreversible myocardial damage, or a marker of patients with limited cardiac reserve at risk for further injury. Lastly, faster heart rate may be a marker for under-use of ß-adrenergic blockade. Because the use of preoperative ß-adrenergic blockade in CABG patients is associated with improved in-hospital survival, further investigation concerning the effect of intraoperative treatment of increased heart rate with ß-adrenergic blockers on mortality after CABG surgery is warranted.

IMPLICATIONS: We conducted an observational study to evaluate the association between heart rate upon arrival to the operating room (preinduction heart rate) and in-hospital mortality during coronary artery bypass graft surgery. After adjustment for baseline differences among patients, preinduction heart rate 80 bpm was associated with an increased in-hospital mortality after coronary artery bypass graft surgery.

This article has been cited by other articles:

				V. Aboyans, M. Frank, K. Nubret, P. Lacroix, and M. Laskar Heart rate and pulse pressure at rest are major prognostic markers of early postoperative complications after coronary bypass surgery Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 971 - 976. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999