The Effect of Bisoprolol on Perioperative Mortality and Myocardial Infarction in High-Risk Patients Undergoing Vascular Surgery
Don Poldermans, Ph.D., Eric Boersma, Ph.D., Jeroen J. Bax, Ph.D., Ian R. Thomson, Ph.D., Louis L.M. van de Ven, Ph.D., Jan D. Blankensteijn, Ph.D., Hubert F. Baars, M.D., Tik-Ien Yo, Ph.D., Giuseppe Trocino, M.D., Carlo Vigna, M.D., Jos R.T.C. Roelandt, Ph.D., Hero van Urk, Ph.D., Paolo M. Fioretti, Ph.D., Bernard Paelinck, M.D., for The Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group
Background Cardiovascular complications are the most importantcauses of perioperative morbidity and mortality among patientsundergoing major vascular surgery.
Methods We performed a randomized, multicenter trial to assessthe effect of perioperative blockade of beta-adrenergic receptorson the incidence of death from cardiac causes and nonfatal myocardialinfarction within 30 days after major vascular surgery in patientsat high risk for these events. High-risk patients were identifiedby the presence of both clinical risk factors and positive resultson dobutamine echocardiography. Eligible patients were randomlyassigned to receive standard perioperative care or standardcare plus perioperative beta-blockade with bisoprolol.
Results A total of 1351 patients were screened, and 846 werefound to have one or more cardiac risk factors. Of these 846patients, 173 had positive results on dobutamine echocardiography.Fifty-nine patients were randomly assigned to receive bisoprolol,and 53 to receive standard care. Fifty-three patients were excludedfrom randomization because they were already taking a beta-blocker,and eight were excluded because they had extensive wall-motionabnormalities either at rest or during stress testing. Two patientsin the bisoprolol group died of cardiac causes (3.4 percent),as compared with nine patients in the standard-care group (17percent, P=0.02). Nonfatal myocardial infarction occurred innine patients given standard care only (17 percent) and in noneof those given standard care plus bisoprolol (P<0.001). Thus,the primary study end point of death from cardiac causes ornonfatal myocardial infarction occurred in 2 patients in thebisoprolol group (3.4 percent) and 18 patients in the standard-caregroup (34 percent, P<0.001).
Conclusions Bisoprolol reduces the perioperative incidence ofdeath from cardiac causes and nonfatal myocardial infarctionin high-risk patients who are undergoing major vascular surgery.
Source Information
From Erasmus Medical Center, Rotterdam, the Netherlands (D.P., E.B., J.J.B., L.L.M.V., J.R.T.C.R., H.U.); the University of Manitoba, Winnipeg, Canada (I.R.T.); University Hospital, Utrecht, the Netherlands (J.D.B.); Twee Steden Ziekenhuis, Tilburg, the Netherlands (H.F.B.); Sint Clara Ziekenhuis, Rotterdam, the Netherlands (T.-I.Y.); San Gerardo Hospital, Monza, Italy (G.T.); and Istituto di Ricovero e Cura a Carattere Scientifico Hospital, San Giovanni Rotondo, Italy (C.V.). Other authors were Paolo M. Fioretti, Ph.D., Istituto di Cardiologia, Azienda Ospedaliera, Santa Maria della Misericordia, Udine, Italy; and Bernard Paelinck, M.D., Ziekenhuis Middelheim, Antwerp, Belgium.
Address reprint requests to Dr. Poldermans at the Department of Vascular Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands, or at poldermans{at}hlkd.azr.nl.
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