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

Kertai, Miklos D

Esper, Stephen A

Akushevich, Igor

Voora, Deepak

Ginsburg, Geoffrey S

Stafford-Smith, Mark

Grichnik, Katherine

Newman, Mark F

Fontes, Manuel L

Smith, Peter

Podgoreanu, Mihai V

Mathew, Joseph P

Cardiothoracic Anesthesia Research Endeavors (CARE) Group

United States

2017-06-05T20:21:26Z

2017-06-05T20:21:26Z

2014-04

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.

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

S0022-5223(13)01168-9

1097-685X

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

eng

Elsevier BV

J Thorac Cardiovasc Surg

10.1016/j.jtcvs.2013.09.067

Adrenergic beta-Antagonists

Aged

Aged, 80 and over

Coronary Artery Bypass

Cytochrome P-450 CYP2D6

Female

Humans

Male

Middle Aged

Preoperative Care

Retrospective Studies

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

Journal article

Voora, Deepak|0000-0003-0015-5179

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

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

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

1368

1375.e3

4

Anesthesiology

Anesthesiology, Cardiothoracic

Biomedical Engineering

Clinical Science Departments

Duke

Duke Cancer Institute

Duke Clinical Research Institute

Duke Population Research Institute

Faculty

Institutes and Centers

Institutes and Provost's Academic Units

Medicine

Medicine, Cardiology

Nursing

Pathology

Physics

Pratt School of Engineering

Sanford School of Public Policy

School of Medicine

School of Nursing

Social Science Research Institute

Surgery

Surgery, Cardiovascular and Thoracic Surgery

Trinity College of Arts & Sciences

University Institutes and Centers

Published

147