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Comparison of new-onset post-operative atrial fibrillation between patients receiving carvedilol and metoprolol after off-pump coronary artery bypass graft surgery

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A Letter to the Editor to this article was published on 18 November 2022

Abstract

Objective

Post-operative atrial fibrillation (POAF) is a common complication of coronary artery bypass graft (CABG) surgery. Previous studies suggest carvedilol is more effective than metoprolol in preventing POAF in on-pump CABG. This study investigated if the same benefit would be seen in off-pump CABG.

Methods

This single-center, retrospective review compared rates of new-onset POAF between adult patients who received carvedilol and metoprolol after off-pump CABG surgery. Safety endpoints included hypotension, bradycardia, dyspnea, and the composite. Multivariate logistic regression was conducted to identify associations between demographics, potential confounders, and beta-blocker dose and POAF. Kaplan–Meier plots and Cox proportional-hazards models examined differences in time-to-event for POAF.

Results

134 patients were included (34 carvedilol and 100 metoprolol). The mean age was 63 years, 70.9% were male, 85% had history of hypertension, 3.7% had history of heart failure with reduced ejection fraction, and 38.8% were taking beta blockers prior to admission. POAF developed in 2 patients (5.8%) in the carvedilol group and 24 patients (24.0%) in the metoprolol group (odds ratio 0.17 [95% CI 0.03–0.83], p = 0.023). Safety endpoints occurred in 10 carvedilol (29.4%) and 44 metoprolol (44.0%) patients (p = 0.134). Hypotension and dyspnea rates were similar between groups; bradycardia occurred more commonly among metoprolol-treated patients (p = 0.040). Time-to-event analyses revealed a hazard ratio = 0.22 (95% CI 0.05–0.93, p = 0.040) for carvedilol use.

Conclusions

In this single-center, retrospective study of off-pump CABG patients, carvedilol was associated with reduced POAF risk and enhanced safety compared to metoprolol.

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Funding

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this manuscript represent those of the authors and do not necessarily represent the official views of HCA or any part of its affiliated entities.

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Author notes

  1. Keeley H. Stone

    Present address: Texas Health Harris Methodist Hospital, 1301 Pennsylvania Ave, Fort Worth, TX, 76104, USA

  2. Caitlin M. Gibson

    Present address: Virginia Commonwealth University School of Pharmacy, 410 N. 12th Street, Richmond, VA, 23298, USA

Authors and Affiliations

  1. Medical City Arlington, 3301 Matlock Road, Arlington, TX, 76015, USA

    Keeley H. Stone, Katie Reynolds, Sondra Davis & Caitlin M. Gibson

  2. Virginia Commonwealth University School of Pharmacy, 410 N. 12th Street, Richmond, VA, 23298, USA

    Benjamin W. Van Tassell

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Stone, K.H., Reynolds, K., Davis, S. et al. Comparison of new-onset post-operative atrial fibrillation between patients receiving carvedilol and metoprolol after off-pump coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg 71, 299–305 (2023). https://doi.org/10.1007/s11748-022-01877-5

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