High-dose β-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients

Harm H.H. Feringa, Jeroen J. Bax, Eric Boersma, Miklos D. Kertai, Simon H. Meij, Wael Galal, Olaf Schouten, Ian R. Thomson, Peter Klootwijk, Marc R.H.M. Van Sambeek, Jan Klein, Don Poldermans

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Abstract

BACKGROUND - Adverse perioperative cardiac events occur frequently despite the use of beta (β)-blockers. We examined whether higher doses of β-blockers and tight heart rate control were associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome. METHODS AND RESULTS - In an observational cohort study, 272 vascular surgery patients were preoperatively screened for cardiac risk factors and β-blocker dose. Beta-blocker dose was converted to a percentage of maximum recommended therapeutic dose. Heart rate and ischemic episodes were recorded by continuous 12-lead electrocardiography, starting 1 day before to 2 days after surgery. Serial troponin T levels were measured after surgery. All-cause mortality was noted during follow-up. Myocardial ischemia was detected in 85 of 272 (31%) patients and troponin T release in 44 of 272 (16.2%). Long-term mortality occurred in 66 of 272 (24.2%) patients. In multivariate analysis, higher β-blocker doses (per 10% increase) were significantly associated with a lower incidence of myocardial ischemia (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.51 to 0.75), troponin T release (HR, 0.63; 95% CI, 0.49 to 0.80), and long-term mortality (HR, 0.86; 95% CI, 0.76 to 0.97). Higher heart rates during electrocardiographic monitoring (per 10-bpm increase) were significantly associated with an increased incidence of myocardial ischemia (HR, 2.49; 95% CI, 1.79 to 3.48), troponin T release (HR, 1.53; 95% CI, 1.16 to 2.03), and long-term mortality (HR, 1.42; 95% CI, 1.14 to 1.76). CONCLUSION - This study showed that higher doses of β-blockers and tight heart rate control are associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome in vascular surgery patients.

Original languageEnglish
Pages (from-to)I344-I349
JournalCirculation
Volume114
Issue numberSUPPL. 1
DOIs
Publication statusPublished - Jul 1 2006

Keywords

  • Beta-blockers
  • Heart rate
  • Ischemia
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Feringa, H. H. H., Bax, J. J., Boersma, E., Kertai, M. D., Meij, S. H., Galal, W., Schouten, O., Thomson, I. R., Klootwijk, P., Van Sambeek, M. R. H. M., Klein, J., & Poldermans, D. (2006). High-dose β-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients. Circulation, 114(SUPPL. 1), I344-I349. https://doi.org/10.1161/CIRCULATIONAHA.105.000463