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BJA Advance Access originally published online on June 12, 2008
British Journal of Anaesthesia 2008 101(4):458-465; doi:10.1093/bja/aen173
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Dihydropiridine calcium-channel blockers and perioperative mortality in aortic aneurysm surgery{dagger}

M. D. Kertai1,2,*, C. M. Westerhout3, K. S. Varga1, G. Acsady1 and J. Gal1,4

1 Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary
2 Department of Cardiothoracic Anaesthesia, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK
3 University of Alberta, Edmonton, Alberta, Canada
4 Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK

* Corresponding author. E-mail: mkertai{at}hotmail.com

Background: Dihydropiridine calcium-channel blockers are often used as an alternative to beta-blockers for the treatment of hypertension in patients undergoing aortic aneurysm surgery. We studied the relation between dihydropiridine calcium-channel blocker use and perioperative mortality in patients undergoing aortic aneurysm surgery.

Methods: We studied 1000 patients [mean (range) age, 69 (22–95) yr; males 810] who underwent acute or elective abdominal or thoracoabdominal aortic aneurysm surgery between January 1999 and April 2007, at Semmelweis Medical University (Budapest, Hungary). Patients were evaluated for clinical risk factors, chronic medication use, and surgical characteristics. Propensity score analysis was used to adjust for the potential bias in dihydropiridine calcium-channel blocker use. Multivariable logistic regression analyses were applied to study the association between the likelihood of dihydropiridine calcium-channel blocker use and mortality occurring within 30 days of surgery.

Results: Perioperative mortality occurred in 85 (8.5%) patients. Thirty-day mortality was significantly higher in dihydropiridine calcium-channel blocker users compared with non-users, 14.0% vs 6.0%; crude odds ratio (OR) 2.6, 95% confidence interval (CI): 1.6–4.0, P<0.0001. Even after correcting for other baseline covariates and propensity for these agents dihydropiridine calcium-channel blocker use was associated with increased 30-day mortality, OR (95% CI) 2.5(1.3–4.6), P=0.003.

Conclusions: Dihydropiridine calcium-channel blocker use in patients with acute or elective aortic aneurysm surgery is independently associated with an increased incidence of perioperative mortality.

Keywords: calcium-channel block, amlodipine; calcium-channel block, nifedipine; complications, death; heart, calcium-channel blockers; risk; surgery, vascular

{dagger} This article is accompanied by Editorial 1


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