• Liangshan Wang, Hong Wang, and Xiaotong Hou.
• Center for Cardiac Intensive Care, Capital Medical University Affiliated Anzhen Hospital, Beijing, People's Republic of China.
• J. Thorac. Cardiovasc. Surg. 2018 Feb 1; 155 (2): 620-629.e1.

ObjectiveThe use of preoperative beta-blockers has been used as a quality standard for patients undergoing coronary artery bypass grafting (CABG). However, the benefits of beta-blockers use before CABG remain controversial. We performed a systematic review and meta-analysis to investigate the short-term effects of preoperative beta-blocker use for patients undergoing isolated CABG.MethodsWe searched PubMed, Embase, and the Cochrane Library for English articles published from inception to August 16, 2016. Observational studies comparing preoperative beta-blockers therapy or non-beta-blockers therapy were considered eligible for the current study.ResultsSix observational studies with 1,231,850 patients were included. The pooled analyses of unadjusted outcome (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71-0.95; P = .007) or risk-adjusted outcome (OR, 0.95; 95% CI, 0.92-0.97; P = .000) showed slight reduction in operative mortality, whereas an insignificant difference in mortality rate was observed in pooling postoperative data from propensity score analysis (OR, 0.97; 95% CI, 0.94-1.00; P = .088). Removing one study that used propensity-score covariate adjustment, subgroup analysis of propensity-matched patients (313,417 in each group) still generated a statistically nonsignificant benefit for preoperative beta-blocker use (OR, 0.97; 95% CI, 0.94-1.00; P = .093). Furthermore, the preoperative use of beta-blockers did not reduce the incidence of major postoperative complications, such as postoperative myocardial infarction, stroke, atrial fibrillation, reoperation, renal failure, prolonged ventilation, and sternal wound infection.ConclusionsOur study suggests that the use of preoperative beta-blockers did not reduce either operative mortality or the incidence of postoperative complications in patients undergoing CABG.Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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