Optimizing long-term cardiac management after major vascular surgery: Role of β-blocker therapy, clinical characteristics, and dobutamine stress echocardiography to optimize long-term cardiac management after major vascular surgery

M. Kertai, Eric Boersma, Jeroen J. Bax, Ian R. Thomson, Maarten J. Cramer, Louis L M Van de Ven, Michael G. Scheffer, Giuseppe Trocino, Carlo Vigna, Hubert F. Baars, Hero Van Urk, Jos R T C Roelandt, Don Poldermans

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Abstract

Background: Survivors of major vascular surgery are at increased risk of late cardiac complications. Objective: To examine the cardioprotective effect of β-blockers. Methods: A follow-up study was conducted in 1286 patients who survived surgery for at least 30 days. Patients were screened for cardiac risk factors and dobutamine stress echocardiography (DSE) results; 1034 patients (80%) underwent preoperative DSE, and 370 (29%) received β-blockers. The main outcome measure was late cardiac death or myocardial infarction. Results: Seventy-four patients (5.8%) had late cardiac events. Cardiac event rates in patients with 0, 1 to 2, and 3 or more risk factors were 1.6%, 4.7%, and 19.2%, respectively. In patients without risk factors, β-blockers were associated with improved event-free survival (2.8% vs 0%), and DSE had no additional prognostic value. In patients with 1 to 2 risk factors, the presence of ischemia during DSE increased cardiac events from 3.9% to 9.8%. However, if patients with ischemia were treated with β-blockers, the risk decreased to 7.2%. In patients with 3 or more risk factors, DSE and β-blockers stratified patients into intermediate- and high-risk groups. In patients without ischemia, β-blockers reduced the cardiac event rate from 15.1% to 9.5%, whereas the cardioprotective effect was limited in patients with 3 or more risk factors and positive DSE findings. Conclusions: Long-term β-blocker use is associated with a reduction in the cardiac event rate, except for patients with 3 or more risk factors and positive findings on DSE.

Original languageEnglish
Pages (from-to)2230-2235
Number of pages6
JournalArchives of Internal Medicine
Volume163
Issue number18
DOIs
Publication statusPublished - Oct 13 2003

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Stress Echocardiography
Blood Vessels
Therapeutics
Ischemia
Disease-Free Survival
Survivors

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Optimizing long-term cardiac management after major vascular surgery : Role of β-blocker therapy, clinical characteristics, and dobutamine stress echocardiography to optimize long-term cardiac management after major vascular surgery. / Kertai, M.; Boersma, Eric; Bax, Jeroen J.; Thomson, Ian R.; Cramer, Maarten J.; Van de Ven, Louis L M; Scheffer, Michael G.; Trocino, Giuseppe; Vigna, Carlo; Baars, Hubert F.; Van Urk, Hero; Roelandt, Jos R T C; Poldermans, Don.

In: Archives of Internal Medicine, Vol. 163, No. 18, 13.10.2003, p. 2230-2235.

Research output: Contribution to journalArticle

Kertai, M. ; Boersma, Eric ; Bax, Jeroen J. ; Thomson, Ian R. ; Cramer, Maarten J. ; Van de Ven, Louis L M ; Scheffer, Michael G. ; Trocino, Giuseppe ; Vigna, Carlo ; Baars, Hubert F. ; Van Urk, Hero ; Roelandt, Jos R T C ; Poldermans, Don. / Optimizing long-term cardiac management after major vascular surgery : Role of β-blocker therapy, clinical characteristics, and dobutamine stress echocardiography to optimize long-term cardiac management after major vascular surgery. In: Archives of Internal Medicine. 2003 ; Vol. 163, No. 18. pp. 2230-2235.
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abstract = "Background: Survivors of major vascular surgery are at increased risk of late cardiac complications. Objective: To examine the cardioprotective effect of β-blockers. Methods: A follow-up study was conducted in 1286 patients who survived surgery for at least 30 days. Patients were screened for cardiac risk factors and dobutamine stress echocardiography (DSE) results; 1034 patients (80{\%}) underwent preoperative DSE, and 370 (29{\%}) received β-blockers. The main outcome measure was late cardiac death or myocardial infarction. Results: Seventy-four patients (5.8{\%}) had late cardiac events. Cardiac event rates in patients with 0, 1 to 2, and 3 or more risk factors were 1.6{\%}, 4.7{\%}, and 19.2{\%}, respectively. In patients without risk factors, β-blockers were associated with improved event-free survival (2.8{\%} vs 0{\%}), and DSE had no additional prognostic value. In patients with 1 to 2 risk factors, the presence of ischemia during DSE increased cardiac events from 3.9{\%} to 9.8{\%}. However, if patients with ischemia were treated with β-blockers, the risk decreased to 7.2{\%}. In patients with 3 or more risk factors, DSE and β-blockers stratified patients into intermediate- and high-risk groups. In patients without ischemia, β-blockers reduced the cardiac event rate from 15.1{\%} to 9.5{\%}, whereas the cardioprotective effect was limited in patients with 3 or more risk factors and positive DSE findings. Conclusions: Long-term β-blocker use is associated with a reduction in the cardiac event rate, except for patients with 3 or more risk factors and positive findings on DSE.",
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T1 - Optimizing long-term cardiac management after major vascular surgery

T2 - Role of β-blocker therapy, clinical characteristics, and dobutamine stress echocardiography to optimize long-term cardiac management after major vascular surgery

AU - Kertai, M.

AU - Boersma, Eric

AU - Bax, Jeroen J.

AU - Thomson, Ian R.

AU - Cramer, Maarten J.

AU - Van de Ven, Louis L M

AU - Scheffer, Michael G.

AU - Trocino, Giuseppe

AU - Vigna, Carlo

AU - Baars, Hubert F.

AU - Van Urk, Hero

AU - Roelandt, Jos R T C

AU - Poldermans, Don

PY - 2003/10/13

Y1 - 2003/10/13

N2 - Background: Survivors of major vascular surgery are at increased risk of late cardiac complications. Objective: To examine the cardioprotective effect of β-blockers. Methods: A follow-up study was conducted in 1286 patients who survived surgery for at least 30 days. Patients were screened for cardiac risk factors and dobutamine stress echocardiography (DSE) results; 1034 patients (80%) underwent preoperative DSE, and 370 (29%) received β-blockers. The main outcome measure was late cardiac death or myocardial infarction. Results: Seventy-four patients (5.8%) had late cardiac events. Cardiac event rates in patients with 0, 1 to 2, and 3 or more risk factors were 1.6%, 4.7%, and 19.2%, respectively. In patients without risk factors, β-blockers were associated with improved event-free survival (2.8% vs 0%), and DSE had no additional prognostic value. In patients with 1 to 2 risk factors, the presence of ischemia during DSE increased cardiac events from 3.9% to 9.8%. However, if patients with ischemia were treated with β-blockers, the risk decreased to 7.2%. In patients with 3 or more risk factors, DSE and β-blockers stratified patients into intermediate- and high-risk groups. In patients without ischemia, β-blockers reduced the cardiac event rate from 15.1% to 9.5%, whereas the cardioprotective effect was limited in patients with 3 or more risk factors and positive DSE findings. Conclusions: Long-term β-blocker use is associated with a reduction in the cardiac event rate, except for patients with 3 or more risk factors and positive findings on DSE.

AB - Background: Survivors of major vascular surgery are at increased risk of late cardiac complications. Objective: To examine the cardioprotective effect of β-blockers. Methods: A follow-up study was conducted in 1286 patients who survived surgery for at least 30 days. Patients were screened for cardiac risk factors and dobutamine stress echocardiography (DSE) results; 1034 patients (80%) underwent preoperative DSE, and 370 (29%) received β-blockers. The main outcome measure was late cardiac death or myocardial infarction. Results: Seventy-four patients (5.8%) had late cardiac events. Cardiac event rates in patients with 0, 1 to 2, and 3 or more risk factors were 1.6%, 4.7%, and 19.2%, respectively. In patients without risk factors, β-blockers were associated with improved event-free survival (2.8% vs 0%), and DSE had no additional prognostic value. In patients with 1 to 2 risk factors, the presence of ischemia during DSE increased cardiac events from 3.9% to 9.8%. However, if patients with ischemia were treated with β-blockers, the risk decreased to 7.2%. In patients with 3 or more risk factors, DSE and β-blockers stratified patients into intermediate- and high-risk groups. In patients without ischemia, β-blockers reduced the cardiac event rate from 15.1% to 9.5%, whereas the cardioprotective effect was limited in patients with 3 or more risk factors and positive DSE findings. Conclusions: Long-term β-blocker use is associated with a reduction in the cardiac event rate, except for patients with 3 or more risk factors and positive findings on DSE.

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