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Pharmacotherapy. 2017 Mar;37(3):297-304. doi: 10.1002/phar.1894. Epub 2017 Feb 3.

Perioperative Inotrope Therapy and Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery: Evidence of a Racial Disparity.

Author information

1
Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.
2
Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina.
3
Center for Health Disparities, Brody School of Medicine, Greenville, North Carolina.
4
Office of the Dean, College of Nursing, East Carolina University, Greenville, North Carolina.
5
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.
6
Department of Pharmacology and Toxicology, Brody School of Medicine, Greenville, North Carolina.
7
Center for Minority Health and Health Disparities Research and Education, Xavier University of Louisiana, New Orleans, Louisiana.
8
Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina.
9
Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
10
Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa.

Abstract

BACKGROUND AND OBJECTIVE:

Following coronary artery bypass graft (CABG) surgery, mortality rates are significantly higher among black patients who experience postoperative atrial fibrillation (POAF). Perioperative inotropic therapy (PINOT) was associated with POAF in previous reports, but the extent to which race influences this association is unknown. In the present study, the relationship between PINOT, race, and POAF was examined in patients undergoing CABG surgery.

METHODS AND SETTING:

Clinical records were examined from a prospectively maintained cohort of 11,855 patients (median age 64 yrs; 70% male; 16% black) undergoing primary isolated CABG at a large cardiovascular institute in the southeastern region of the United States. Relative risk (RR) and 95% confidence intervals (CIs) were computed using log-binomial regression.

MAIN RESULTS:

The association between PINOT and POAF was significantly increased among black patients (adjusted RR 1.7, CI 1.4-2.0) compared with white patients (adjusted RR 1.3, CI 1.2-1.4) (pinteraction  = 0.013).

CONCLUSIONS:

These findings suggest that PINOT may be disproportionately associated with POAF among black patients undergoing CABG surgery. Additional studies are needed to examine further the potential underlying mechanisms of this association.

KEYWORDS:

coronary artery bypass graft; inotrope; postoperative atrial fibrillation; race

PMID:
28052357
PMCID:
PMC5505772
DOI:
10.1002/phar.1894
[Indexed for MEDLINE]
Free PMC Article

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