Key result
Prior beta-blocker use before aneurysmal subarachnoid hemorrhage is linked to ~8-fold higher ventricular ectopy risk.
Why the study?
Cardiac abnormalities due to adrenergic surge are common after aneurysmal subarachnoid hemorrhage, and the effect of adrenergic blockade medications on early cardiac complications is unclear.
Does prescribed use of beta-blockers and/or angiotensin-converting enzyme inhibitors before aneurysmal subarachnoid hemorrhage prevent early cardiac complications in adult patients after acute aneurysmal subarachnoid hemorrhage?
Cohort (n=254)
Does prescribed use of beta-blockers and/or angiotensin-converting enzyme inhibitors before aneurysmal subarachnoid hemorrhage prevent early cardiac complications in adult patients after acute aneurysmal subarachnoid hemorrhage?
Odds Ratio: 8
p-value: p=0.02
Prior use of beta-blockers or ACE inhibitors does not protect against, and may be associated with increased, ventricular ectopy following acute aneurysmal subarachnoid hemorrhage.
Prior β-blocker use may increase post-aSAH ventricular ectopy; challenges presumed protection and leaves open prospective validation.
BACKGROUND: Cardiac abnormalities attributed to adrenergic surge are common after aneurysmal subarachnoid hemorrhage. Prescribed medications that block adrenergic stimulation may suppress the onset of cardiopulmonary compromise in patients after aneurysmal subarachnoid hemorrhage. OBJECTIVES: To compare the incidence of early cardiac complications between patients who reported prescribed use of β-blockers and/or angiotensin-converting enzyme inhibitors before aneurysmal subarachnoid hemorrhage and patients who did not. METHODS: A retrospective review of 254 adult patients after acute aneurysmal subarachnoid hemorrhage who were enrolled in an existing R01 study. Demographic data and history were obtained from patients'/proxies' reports and charts. Cardiac enzyme levels, 12-lead electrocardiograms, and chest radiographs were obtained on admission. Holter monitoring and echocardiograms were completed as a part of the R01 study. RESULTS: Patients reporting prescribed use of angiotensin-converting enzyme inhibitors or β-blockers before aneurysmal subarachnoid hemorrhage had more ventricular and supraventricular ectopy on a Holter report than did patients who did not (P < .05). When age, race, sex, and injury (Fisher grade) were controlled for, patients reporting use of β-blockers were 8 times more likely than others to have occasional to frequent ventricular ectopy (P = .02). CONCLUSION: No concrete evidence was found that exposure to adrenergic blockade before aneurysmal subarachnoid hemorrhage provides protection from neurocardiac injury.
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Crago et al. (2014) conducted a cohort in Aneurysmal subarachnoid hemorrhage (n=254). β-blockers and/or angiotensin-converting enzyme inhibitors vs. No prescribed use of β-blockers or ACE inhibitors was evaluated on Occasional to frequent ventricular ectopy (OR 8, p=0.02). Prior use of β-blockers before aneurysmal subarachnoid hemorrhage was associated with an 8-fold increased likelihood of occasional to frequent ventricular ectopy (P=0.02).
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