The Association Between Heart Rate and In-Hospital Mortality After Coronary Artery Bypass Graft Surgery

• Published in: Anesthesia and analgesia Vol. 95; no. 6; pp. 1483 - 1488
• Main Authors: Fillinger, Mary P, Surgenor, Stephen D, Hartman, Gregg S, Clark, Cantwell, Dodds, Thomas M, Rassias, Athos J, Paganelli, William C, Marshall, Peter, Johnson, David, Kelly, Dennis, Galatis, Dean, Olmstead, Elaine M, Ross, Cathy S, O’Connor, Gerald T
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.12.2002; Lippincott
• Subjects: Adrenergic beta-Antagonists - pharmacology; Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Coronary Artery Bypass - mortality; Female; Heart Rate - drug effects; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Human; Postoperative; Mortality; Cardiovascular disease; General anesthesia; Coronary heart disease; Cardiopulmonary bypass; Heart rate; Tachycardia; Aortocoronary; Bypass; Surgery; Risk factor; Complication; Hemodynamics; Preoperative
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-200212000-00005

Avoidance of tachycardia is a commonly described goal for anesthetic management during coronary artery bypass graft (CABG) surgery. However, an association between increased intraoperative heart rate and mortality has not been described. We conducted an observational study to evaluate the association between preinduction heart rate (heart rate upon arrival to the operating room) and in-hospital mortality during CABG surgery. Data were collected on 5934 CABG patients. Fifteen percent of patients had an increased preinduction heart rate ≥80 bpm. Crude mortality was significantly more frequent among patients with increased preinduction heart rate (Ptrend = 0.002). After adjustment for baseline differences among patients, preinduction heart rate ≥80 bpm remained associated with increased mortality (Ptrend < 0.001). The increased heart rate may be a cause of the observed mortality. Alternatively, faster heart rate may be either a marker of patients with irreversible myocardial damage, or a marker of patients with limited cardiac reserve at risk for further injury. Lastly, faster heart rate may be a marker for under-use of β-adrenergic blockade. Because the use of preoperative β-adrenergic blockade in CABG patients is associated with improved in-hospital survival, further investigation concerning the effect of intraoperative treatment of increased heart rate with β-adrenergic blockers on mortality after CABG surgery is warranted.