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J Thorac Cardiovasc Surg 2004;127:755-762
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Calcium antagonists are associated with reduced mortality after cardiac surgery: a propensity analysis

^a Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
^b Department of Anesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada
^c Division of Cardiac Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
^d Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Received for publication October 1, 2002; accepted for publication April 11, 2003.

^* Address for reprints: W. Scott Beattie, MD, PhD, Department of Anaesthesia, University of Toronto, EN 3-453, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada
scott.beattie{at}uhn.on.ca

OBJECTIVES: Observational studies have questioned the effectiveness of perioperative calcium channel blockers but failed to correct for selection biases. We therefore performed a prospective observational cohort study of the effects of calcium channel blockers on cardiac surgical mortality. A propensity score technique was used for risk adjustment.

METHODS: We identified 6619 patients who underwent nontransplant cardiac surgery at the Toronto General Hospital (Toronto, Ontario, Canada) between May 1999 and December 2001. Propensity scores for calcium channel blocker use were constructed for the entire sample and for the subgroup (n = 5222) that underwent coronary artery bypass grafting. The calcium channel blocker adjusted odds ratio for in-hospital mortality after cardiac surgery was determined by using multiple logistic regression and propensity matched-pairs analyses. A subgroup analysis was performed for patients who underwent coronary artery bypass grafting: the calcium channel blocker adjusted odds ratio for mortality was determined by using propensity score matched-pairs analyses.

RESULTS: Calcium channel blockers were associated with significantly reduced cardiac surgical mortality after adjustment with both multiple logistic regression (odds ratio, 0.56; 95% confidence interval, 0.33-0.94; P = .028) and propensity score matched-pairs analyses (odds ratio, 0.56; 95% confidence interval, 0.32-0.98; P = .042). Calcium channel blockers were also associated with reduced mortality (odds ratio, 0.48; 95% confidence interval, 0.23-0.98; P = .044) among patients who underwent coronary artery bypass grafting.

CONCLUSIONS: After adjustment for baseline differences, calcium channel blockers were associated with significantly reduced mortality after cardiac surgery. This benefit also extends to the subgroup that underwent coronary artery bypass grafting. A large randomized controlled trial of perioperative calcium channel blockers is therefore warranted.

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