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Invited Commentary |

Preoperative β-Blockade in Coronary Artery Bypass Grafting Surgery

David M. Shahian, MD1,2
[+] Author Affiliations
1Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital, Boston
2Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2014;174(8):1328-1329. doi:10.1001/jamainternmed.2014.155.
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In the current issue, Brinkman and colleagues1 use the Society of Thoracic Surgeons National Database (STS-ND) to study the effect of preoperative β-blockade on postoperative coronary artery bypass grafting (CABG) outcomes. Their results show no mortality advantage and a paradoxically increased incidence of atrial fibrillation (AF) in patients receiving preoperative β-blockers, findings that challenge the continuation of this practice and its use as a quality metric. I will examine the rationale for preoperative β-blockade, controversies regarding its use in noncardiac surgery, the value of β-blockade in CABG, and reasonable clinical recommendations based on the preponderance of current evidence.

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