Drug therapy before coronary artery surgery: Nitrates are independent predictors of mortality and beta-adrenergic blockers predict survival

We conducted this study to evaluate whether there is an association between preoperative drug therapy and in-hospital mortality in patients undergoing coronary artery graft surgery. We collected data on 1593 consecutive patie nts undergoing coronary artery surgery. The relative risk of in-hospital mo rtality was determined by logistic regression with in-hospital mortality as the dependent variable, and independent variables that included known risk factors and preoperative cardioactive or antithrombotic drug treatment, i. e., age; left ventricular function; left main coronary artery disease; urge nt priority; gender; previous cardiac surgery; concurrent cardiovascular su rgery; chronic lung disease; creatinine concentration; hemoglobin concentra tion; diabetes; hypertension; cerebrovascular disease; recent myocardial in farction; prior vascular surgery; number of arteries bypassed; and regular daily treatment with beta-blockers, aspirin within 5 days, calcium antagoni sts, angiotensin converting enzyme (ACE) inhibitors, digoxin, or warfarin. In-hospital mortality was 3.3%. The relative risk of in-hospital mortality (with 95% confidence intervals of the relative risk) associated with the fo llowing drug treatments was: nitrates 3.8 (1.5-9.6), beta-blockers 0.4 (0.2 -0.8), aspirin within 5 days 1.0 (0.5-1.9), calcium antagonists 1.1 (0.6-2. 1), ACE inhibitors 0.8 (0.4-1.5), digoxin 0.7 (0.2-1.8), and warfarin 0.3 ( 0.1-1.6). We conclude that in-hospital mortality is positively associated w ith preoperative nitrate therapy and negatively associated with beta-adrene rgic blocker therapy. A significant association between in-hospital mortali ty and the preoperative use of calcium antagonists, ACE inhibitors, aspirin , digoxin, and warfarin was not confirmed. Implications: We examined the as sociation between common drug treatments for ischemic heart disease and sho rt-term survival after cardiac surgery using a statistical method to adjust for patients' preoperative medical condition. Death after surgery was more likely after nitrate therapy and less likely after beta-blocker therapy.