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

Miklos D. 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

ASJC Scopus subject areas

  • Internal Medicine

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    Kertai, M. D., Boersma, E., Bax, J. J., Thomson, I. R., Cramer, M. J., Van de Ven, L. L. M., Scheffer, M. G., Trocino, G., Vigna, C., Baars, H. F., Van Urk, H., Roelandt, J. R. T. C., & Poldermans, D. (2003). 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. Archives of Internal Medicine, 163(18), 2230-2235. https://doi.org/10.1001/archinte.163.18.2230