Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction: Atrial fibrillation (AF) is the most common arrhythmia following coronary artery bypass grafting (CABG).
Research Question or Hypothesis: There is no difference between selective beta-blockers in the occurrence of postoperative atrial fibrillation (POAF) after CABG.
Study Design: A retrospective observational cohort study.
Methods: We performed a single center retrospective study of CABG patients who received metoprolol or bisoprolol within 72-hours after surgery between January 1st, 2020 and January 31st, 2023 at a quaternary care center in the Middle-East. The primary endpoint was to identify factors associated with the occurrence of POAF. Multivariate logistic regression was utilized to identify factors predicting occurrence of POAF, and a p-value <0.05 was considered statistically significant.
Results: A total of 323 patients were included in the study; median age was 58 (50-65) years and 9.9% were female. Forty-two (13%) patients developed POAF. The median Society of Thoracic Surgeons (STS) score of the group which developed POAF was 7.53 (5.87-7.53) versus 8.54 (5.90-12.98) for those who did not develop POAF (p=0.559). Univariate analysis showed pre-CABG ejection fraction (EF), on versus off-pump surgery, and diagnosis at presentation were significantly different between both groups. The multivariate logistic regression analysis revealed that bisoprolol exhibited an increased risk of POAF compared to metoprolol tartrate (OR: 2.92, 95% CI [1.125,7.576], p=0.028). Other significant predictors of POAF included advanced age (OR: 1.043, 95% CI [1.001,1.087], p=0.045), lower initial magnesium postoperative level (OR: 0.078, 95% CI [0.013,0.481], p=0.006), higher pre-CABG left atrial volume (OR: 1.038, 95% CI [1.003,1.075], p=0.034), and number of grafted vessels (OR: 0.444, 95% CI [0.239,0.825], p=0.01).
Conclusion: Our findings suggest that several factors can predict POAF however, beta-blockers might have the most significant effect. Our study emerges from a region of high utilization of bisoprolol post CABG and offers important insights on the best choice of beta-blocker. A larger prospective randomized study is needed to confirm our findings.
Presenting Author
Wadima Alnaqeeb B. S. PharmCleveland Clinic Abu Dhabi
Authors
Emna Abidi PhD
Cleveland Clinic Abu Dhabi
Bassam Atallah PharmD, MS, BCPS
Cleveland Clinic Abu Dhabi
Gopal Bhatnagar MD
Cleveland Clinic Abu Dhabi
Wasim Elnekidy PharmD, BCPS, BCACP
Cleveland Clinic Abu Dhabi
Caitlin Gibson PharmD, MEd, BCPS, BCCP
Virginia Commonwealth University School of Pharmacy
Laszlo Göbölös MD PhD
Cleveland Clinic Abu Dhabi