β-Blockers improve in-hospital and long-term survival in patients with severe left ventricular dysfunction undergoing major vascular surgery

H. H.H. Feringa, J. J. Bax, O. Schouten, M. D. Kertai, L. L.M. van de Ven, S. Hoeks, M. R.H.M. van Sambeek, J. Klein, D. Poldermans

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Abstract

Objectives. To study whether β-blockers reduce in-hospital and long-term mortality in patients with severe left ventricular dysfunction (LVD) undergoing major vascular surgery. Design. Observational cohort study. Materials. Five hundred and eleven patients with severe LVD (ejection fraction<30%) undergoing major non-cardiac vascular surgery. Methods. In all patients, cardiac risk factors, medication (including β-blockers), and dobutamine stress echocardiography (DSE) results were noted prior to surgery. DSE was evaluated for rest and stress-induced new wall motion abnormalities. Endpoint was in-hospital and long-term mortality. Propensity scores for β-blockers were calculated and regression models were used to analyse the relation between β-blockers and mortality. Results. Mean age was 64± 11 years and 383 patients (75%) were male. 139 patients (27%) used β-blockers. Stress-induced ischemia occurred in 82 patients (16%). Median follow-up was 7 years (interquartile range: 3-10). In-hospital and long-term mortality was observed in 64 (13%) and 171 (33%) patients, respectively. After adjusting for clinical variables, DSE results and propensity scores, β-blockers were significantly associated with reduced in-hospital and long-term mortality (OR: 0.18, 95% CI: 0.04-0.74 and HR: 0.38, 95% CI: 0.22-0.65, respectively). Conclusion. In patients with severe LVD undergoing major vascular surgery, the use of β-blockers is associated with a reduced incidence of in-hospital and long-term postoperative mortality.

Original languageEnglish
Pages (from-to)351-358
Number of pages8
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume31
Issue number4
DOIs
Publication statusPublished - Apr 1 2006

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Keywords

  • Dobutamine stress echocardiography
  • Major vascular surgery
  • Prognosis
  • Severe left ventricular dysfunction
  • β-Blockers

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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