Sage Journals: Discover world-class research

Abstract

We have evaluated the safety and efficacy of routine β-blockade for the prevention of cardiac complications in a comprehensive series of patients undergoing major vascular surgery and amputation for atherosclerotic arterial disease.

From 1 December 2001 to 31 May 2002, patients received perioperative β-blockade by atenolol. Outcomes in this period were compared to the immediately antecedent 6 months. The main outcome measure was the occurrence of cardiac complications.

Fifty-three patients underwent surgery in the first period and 54 in the second. After introduction of routine β-blockade, only one patient suffered cardiac complications compared to 10 in the first period (P = 0.01). There were eight deaths in the first and two in the second period (P = 0.052). On multivariate analysis, treatment with β-blockers was the only variable significantly associated with a decrease in cardiac morbidity (OR = 0.12; 95% Cl = 0.002–0.66; P = 0.014). Two patients suffered bronchospasm leading to discontinuation of atenolol. Routine perioperative β-blockade was safe and reduced the occurrence of cardiac complications after vascular surgery.

Keywords

β-blockers vascular surgery myocardial infarction cardiac failure arrhythmia

Get full access to this article

View all access options for this article.

References

Lawrence

P. F.

, Gazak

, Bhirangi

The epidemiology of surgically repaired aneurysms in the United States. J Vasc Surg, 1999, 30, 632–640.

Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants. Lancet 1998, 353, 1649–55.

Bayly

P. J.

, Matthews

J. N.

, Dobson

P. M.

In-hospital mortality from abdominal aortic surgery in Great Britain and Ireland: Vascular Anaesthesia Society audit. Br J Surg, 2001, 88, 687–692.

Seeger

J. M.

, Pretus

H. A.

, Carlton

L. C.

Potential predictors of outcome in patients with tissue loss who undergo infrainguinal vein bypass grafting. J Vasc Surg, 1999, 30, 427–435.

Harrington

M. E.

, Harrington

E. B.

, Haimov

Axillofemoral bypass: compromised bypass for compromised patients. J Vasc Surg, 1994, 20, 195–201.

Wong

J. C.

, Torella

, Haynes

S. L.

Autologous versus allogeneic transfusion in aortic surgery: a multicenter randomized clinical trial. Ann Surg, 2002, 235, 145–151.

Pasternack

P. F.

, Imparato

A. M.

, Baumann

F. G.

The hemodynamics of beta-blockade in patients undergoing abdominal aortic aneurysm repair. Circulation, 1987, 76(III), 1–7.

Paciaroni

, Eliasziw

, Kappelle

L. J.

Medical complications associated with carotid endarterectomy. North American symptomatic carotid endarterectomy trial (NASCET). Stroke, 1999, 30, 1759–1763.

Haggart

P. C.

, Adam

D. J.

, Ludman

P. F.

Comparison of cardiac troponin I and creatine kinase ratios in the detection of myocardial injury after aortic surgery. Br J Surg, 2001, 88, 1196–1200.

10.

Auerbach

A. D.

and Goldman

Beta-blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA, 2002, 287, 1435–1444.

11.

Mangano

D. T.

, Layug

E. L.

, Wallace

Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med, 1996, 335, 1713–1720.

12.

Poldermans

, Boersma

, Bax

J. J.

The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med, 1999, 341, 1789–1794.

13.

Raby

K. E.

, Brull

S. J.

, Timimi

The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg, 1999, 88, 477–482.

14.

MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002, 360, 7–22.

15.

Pasternack

P. F.

, Imparato

A. M.

, Baumann

F. G.

The hemodynamics of β-blockade in patients undergoing aortic aneurysm repair. Circulation, 1987, 76(Suppl III), 1–7.

16.

Sharma

S. K.

, Kini

, Marmur

J. D.

Cardioprotective effect of previous β-blocker therapy in reducing creatine kinase-MB elevation after coronary intervention. Circulation, 2000, 102, 166–172.

17.

Lee

T. H.

, Marcantonio

E. R.

, Mangione

C. M.

Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation, 1999, 100, 1043–1049.

18.

Michaels

J. A.

, Kayne

S. P. K.

and Galland

R. B.

A survey of methods used for cardiac risk assessment prior to major vascular surgery. Eur J Vasc Endovasc Surg, 1996, 11, 221–224.

19.

Das

M. K.

, Pellikka

P. A.

, Mahoney

D. W.

Assessment of cardiac risk before nonvascular surgery: dobutamine stress echocardiography in 530 patients. J Am Coll Cardiol, 2000, 35, 1647–1653.

20.

Boucher

C. A.

, Brewster

D. C.

, Darling

R. C.

Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med, 1985, 312, 389–394.

21.

Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery. American College of Physicians. Ann Intern Med 1997, 127, 309–312.

22.

Wallace

, Layug

, Tateo

Prophylactic atenolol reduces postoperative myocardial ischemia. Anesthesiology, 1998, 88, 7–17.

Routine β-Blockade in Vascular Surgery

Abstract

Keywords

Get full access to this article

References