Heterogeneous effects of preoperative beta blockers on 30-day mortality after coronary artery bypass surgery

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ventricular dysfunction (LVEF ≤50%) undergoing CABG (n=6492). Intervention: Preoperative β-blocker therapy vs. No preoperative β-blocker therapy. Primary outcome: 30-day all-cause mortality (overall matched cohort) (p=0.056).

Q: What does this research mean for the field?

Preoperative beta-blocker therapy has heterogeneous effects on 30-day mortality in patients with ventricular dysfunction undergoing CABG, providing superior outcomes specifically in those with concomitant renal dysfunction (eGFR ≤ 66 mL/min/1.73 m²). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Wenyuan Lu; Hanwei Tang; Jingyu Wang; Jianing Han; Yuanming Li; Xin Wang; Jianfeng Hou

doi:10.1080/07853890.2026.2719256

September 4, 2026Annals of MedicineOpen Access

Heterogeneous effects of preoperative beta blockers on 30-day mortality after coronary artery bypass surgery

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Key result

Preoperative β-blockers fail to reduce 30-day mortality overall, but benefit patients with impaired renal function.

P=0.056
n=6,492

Figures

Why the study?

The role of preoperative beta-blocker therapy in patients with ventricular dysfunction undergoing CABG remains unclear.

Does preoperative β-blocker therapy reduce 30-day mortality in patients with ventricular dysfunction undergoing CABG?

Key Points

To evaluate heterogeneous treatment effects of preoperative beta-blocker therapy on 30-day mortality in patients with ventricular dysfunction undergoing coronary artery bypass grafting (CABG).
Analyzed data from 6,492 patients with ventricular dysfunction undergoing CABG in the Chinese Cardiac Surgery Registry database between 2017 and 2020.
Conducted propensity score matching to generate 2,489 matched pairs (4,978 patients total) and applied a machine-learning iterative causal forest (iCF) algorithm to estimate individualized treatment effects on 30-day all-cause mortality.
In the matched cohort overall, preoperative beta-blocker therapy was not significantly associated with 30-day all-cause mortality, with 83 deaths among 2,489 treated patients versus 110 deaths among 2,489 untreated patients (p=0.056).
The iterative causal forest identified eGFR, LVEDD, and BMI as key effect modifiers, revealing significant survival benefit only among patients with eGFR ≤ 66 mL/min/1.73 m² (aOR, 0.39; 95% CI, 0.22 to 0.67; p=0.001; aRD, -6%; 95% CI, -10% to -2%).
Patients with eGFR > 66 mL/min/1.73 m² and LVEDD > 62 mm showed a nominal association with higher 30-day mortality following preoperative beta-blocker use (aOR, 2.27; 95% CI, 1.03 to 5.40; p=0.050; aRD, 3%; 95% CI, 0 to 5%).

Study Design

Type

Cohort (n=6,492)

Multicenter

Yes

Structured PICO

Does preoperative β-blocker therapy reduce 30-day mortality in patients with ventricular dysfunction undergoing CABG?

P

Population

6,492 patients with ventricular dysfunction (LVEF ≤50%) undergoing coronary artery bypass grafting, mean age 61, 16% female, evaluated for 30-day mortality.

E

Exposure

Preoperative β-blocker therapy (at least one dose of any β-blocker within 24 hours before CABG).

C

Comparator

No preoperative β-blocker therapy within 24 hours before CABG.

O

Outcome

30-day all-cause mortality after CABG.hard clinical

Main Result

Absolute Event Rate: 3.3% vs 4.4%

p-value: p=0.056

Limitations

Dataset lacked specific type of β-blockers, dosage, timing, or duration
Lack of detailed intraoperative variables and other guideline-directed medical therapies
Limited to short-term outcomes
Data-driven eGFR threshold requires further validation
Dataset did not capture specific type of β-blockers, dosage, timing, or duration
eGFR threshold was data-driven and requires validation

Implication

Demonstrates that while preoperative beta-blockers may not benefit all CABG patients with ventricular dysfunction, those with concomitant renal impairment (eGFR ≤ 66) derive significant short-term mortality reduction.

Abstract

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Discussion

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Cite This Study

Lu et al. (2026) conducted a cohort in Ventricular dysfunction (LVEF ≤50%) undergoing CABG (n=6,492). Preoperative β-blocker therapy vs. No preoperative β-blocker therapy was evaluated on 30-day all-cause mortality (overall matched cohort) (p=0.056). Preoperative β-blockers did not significantly reduce 30-day mortality overall (p=0.056), but machine learning identified a 61% mortality reduction in patients with eGFR ≤ 66 mL/min/1.73 m2.

synapsesocial.com/papers/6a9c01146b95aff0620ec80c https://doi.org/10.1080/07853890.2026.2719256

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Heterogeneous effects of preoperative beta blockers on 30-day mortality after coronary artery bypass surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Heterogeneous effects of preoperative beta blockers on 30-day mortality after coronary artery bypass surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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