| Acute surgical anemia influences the cardioprotective effects of beta-blockade: a single-center, propensity-matched cohort study. | |
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MedLine Citation:
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PMID: 20032700 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Despite decreasing cardiac events, perioperative beta-blockade also increases perioperative stroke and mortality. Major bleeding and/or hypotension are independently associated with these outcomes. To investigate the hypothesis that beta-blockade limits the cardiac reserve to compensate for acute surgical anemia, the authors examined the relationship between cardiac events and acute surgical anemia in patients with and without beta-blockade. METHODS: The records of all noncardiac, nontransplant surgical patients between March 2005 and June 2006 were retrospectively retrieved. The primary outcome was a composite that comprised myocardial infarction, nonfatal cardiac arrest, and in-hospital mortality (major adverse cardiac event). The lowest recorded hemoglobin in the first 3 days defined nadir hemoglobin. Propensity scores estimating the probability of receiving a perioperative beta-blocker were used to match (1:1) patients who did or did not receive beta-blockers postoperatively. The relationship between nadir hemoglobin and major adverse cardiac event was then assessed. RESULTS: This analysis identified 4,387 patients in whom nadir hemoglobin could be calculated; 1,153 (26%) patients were administered beta-blockers within the first 24 h of surgery. Propensity scores created 827 matched pairs that were well balanced for all measured confounders. Major adverse cardiac event occurred in 54 (6.5%) beta-blocked patients and in 25 (3.0%) beta-blocker naive patients (relative risk 2.38; 95% CI 1.43-3.96; P = 0.0009). The restricted cubic spline relationship demonstrated that this difference was restricted to those patients in whom the hemoglobin decrease exceeded 35% of the baseline value. CONCLUSIONS: beta-Blocked patients do not seem to tolerate surgical anemia when compared with patients who are naive to beta-blockers. Prospective studies are required to validate these findings. |
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Authors:
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W Scott Beattie; Duminda N Wijeysundera; Keyvan Karkouti; Stuart McCluskey; Gordon Tait; Nicholas Mitsakakis; Gregory M T Hare |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 112 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2009-12-24 Completed Date: 2010-01-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 25-33 Citation Subset: AIM; IM |
Affiliation:
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Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. scott.beattie@uhn.on.ca |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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pharmacology* Adult Aged Algorithms Anemia / etiology, physiopathology* Blood Loss, Surgical / physiopathology* Cardiotonic Agents* Cohort Studies Databases, Factual Heart Arrest / etiology Hemoglobins / metabolism Hospital Mortality Humans Intraoperative Complications / physiopathology* Ischemia / physiopathology Middle Aged Myocardial Infarction / prevention & control Prospective Studies Retrospective Studies Risk Factors Survival Analysis Treatment Outcome Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Cardiotonic Agents; 0/Hemoglobins |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2010 Jan;112(1):12-5
[PMID:
20032697
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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