Neuroprotection is associated with β-adrenergic receptor antagonists during cardiac surgery: Evidence from 2,575 patients

David W. Amory, Alina Grigore, John K. Amory, Mark A. Gerhardt, William D. White, Peter K. Smith, Debra A. Schwinn, J. G. Reves, Mark F. Newman

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


Objective: To determine the impact of perioperative β-adrenergic receptor (βAR) antagonist administration on neurologic complications. Design: Observational database analysis. Setting: A clinical investigation at a single tertiary academic medical center. Participants: Elective coronary artery bypass graft surgical patients operated on in the period 1994-1996. Interventions: Patients were divided into 2 groups: (1) patients given βAR antagonist-blocking drugs in the perioperative period, including during operation, and (2) patients not given βAR antagonists. Measurements and Main Results: βAR antagonist use in 2,575 consecutive patients undergoing coronary artery bypass graft surgery (1994-1996) was determined using the Cardiovascular Database and Anesthesia Information System Database. Outcome variables were postoperative stroke, coma, and transient ischemic attack. Of patients, 113 (4.4%) had postoperative neurologic complications, including stroke (n = 44), coma (n = 12), and transient ischemic attack (n = 3). Of patients, 2,296 (89%) received perioperative βAR antagonist therapy, and 279 (11%) did not. Adverse neurologic events occurred in 3.9% (n = 90) of patients who received perioperative βAR antagonists and 8.2% (n = 23) of patients who did not receive βAR antagonists (odds ratio, 0.45; 95% confidence interval, 0.28 to 0.73; p = 0.003, unadjusted.) Severe neurologic outcomes (stroke and coma) occurred in 1.9% (n = 44) of patients who received βAR antagonists and 4.3% (n = 12) of patients who did not receive βAR antagonists (odds ratio, 0.43; 95% confidence interval, 0.23 to 0.83; p = 0.016). Conclusion: Use of β-adrenergic antagonists was associated with a substantial reduction in the incidence of postoperative neurologic complications. A prospective randomized trial is needed to verify this potentially important neuroprotective strategy in cardiac surgery.

Original languageEnglish
Pages (from-to)270-277
Number of pages8
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number3
StatePublished - 2002

Bibliographical note

Funding Information:
Supported by NIH grants RO1-AG09663 (J.G.R.), 1RO1-HL54316 (M.F.N.), RO1-HL57447 (D.A.S.), KO2-AG00545 (D.A.S.), #HL57447 (D.A.S.), and AG00745 (D.A.S.), American Heart Association Grant-In-Aid, #95010970 (M.F.N.), and NIH MOI-RR-30.


  • Cardiac surgical procedures
  • Coma
  • Coronary artery bypass graft (CABG) surgery
  • Neurologic complications
  • Neuroprotection
  • Stroke
  • Transient ischemic attack (TIA)
  • β-adrenergic blockers
  • β-adrenergic receptor (βAR)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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