Preoperative CYP2D6 metabolism-dependent β-blocker use and mortality after coronary artery bypass grafting surgery.

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Kertai, Miklos D

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Esper, Stephen A

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Akushevich, Igor

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Voora, Deepak

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Ginsburg, Geoffrey S

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Stafford-Smith, Mark

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Grichnik, Katherine

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Newman, Mark F

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Fontes, Manuel L

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Smith, Peter

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Podgoreanu, Mihai V

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Mathew, Joseph P

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Cardiothoracic Anesthesia Research Endeavors (CARE) Group

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United States

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2017-06-05T20:21:26Z

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2017-06-05T20:21:26Z

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2014-04

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OBJECTIVE: Recently, the role of β-blockers (BBs) in reducing perioperative mortality has been challenged. The conflicting results might have resulted from the extent of BB metabolism by the cytochrome P-450 (CYP2D6) isoenzyme. The purpose of the present study was to assess the association between the preoperative use of BBs dependent on metabolism of the CYP2D6 isoenzyme with operative mortality after coronary artery bypass grafting surgery. METHODS: We performed a retrospective study of 5248 patients who had undergone coronary bypass grafting surgery from January 1, 2001 to November 30, 2009 at Duke University Medical Center. The cohorts were defined by the preoperative use of BBs and BB type (non-CYP2D6_BBs, CYP2D6_BBs, or no BBs). Operative mortality was analyzed using inverse probability-weighted estimators with propensity score adjustment. RESULTS: Of the 5248 patients, 14% received non-CYP2D6_BBs, 43%, CYP2D6_BBs, and 43%, no BBs. The incidence of operative mortality was 0.8%, 2.1%, and 3.7% in the non-CYP2D6_BB, CYP2D6_BB, and no BB groups, respectively. Multivariable inverse probability-weighted-adjusted analyses showed that non-CYP2D6_BBs were associated with a lower incidence of operative mortality (odds ratio, 0.33; 95% confidence interval, 0.13-0.83; P = .02) compared with no BB use and a trend toward lower operative mortality (odds ratio, 0.44; 95% confidence interval, 0.16-1.07; P = .06) compared with CYP2D6_BBs. No significant decrease occurred in the risk of operative mortality between the CYP2D6_BB and no BB groups (odds ratio, 0.85; 95% confidence interval, 0.54-1.34; P = .48). CONCLUSIONS: Among these patients, preoperative non-CYP2D6_BB use, but not CYP2D6_BB use, was associated with a decreased risk of operative mortality.

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https://www.ncbi.nlm.nih.gov/pubmed/24269121

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S0022-5223(13)01168-9

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1097-685X

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https://hdl.handle.net/10161/14831

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eng

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Elsevier BV

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J Thorac Cardiovasc Surg

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10.1016/j.jtcvs.2013.09.067

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Adrenergic beta-Antagonists

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Aged

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Aged, 80 and over

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Coronary Artery Bypass

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Cytochrome P-450 CYP2D6

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Female

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Humans

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Male

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Middle Aged

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Preoperative Care

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Retrospective Studies

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Preoperative CYP2D6 metabolism-dependent β-blocker use and mortality after coronary artery bypass grafting surgery.

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Journal article

duke.contributor.orcid

Voora, Deepak|0000-0003-0015-5179

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Ginsburg, Geoffrey S|0000-0003-4739-9808

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Mathew, Joseph P|0000-0002-3815-4131

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https://www.ncbi.nlm.nih.gov/pubmed/24269121

pubs.begin-page

1368

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1375.e3

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4

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Anesthesiology

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Anesthesiology, Cardiothoracic

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Biomedical Engineering

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Clinical Science Departments

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Duke

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Duke Cancer Institute

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Duke Clinical Research Institute

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Duke Population Research Institute

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Faculty

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Institutes and Centers

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Institutes and Provost's Academic Units

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Medicine

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Medicine, Cardiology

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Nursing

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Pathology

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Physics

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Pratt School of Engineering

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Sanford School of Public Policy

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School of Medicine

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School of Nursing

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Social Science Research Institute

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Surgery

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Surgery, Cardiovascular and Thoracic Surgery

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Trinity College of Arts & Sciences

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University Institutes and Centers

pubs.publication-status

Published

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147

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