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Previous Volume 341:1789-1794 December 9, 1999 Number 24 Next

	Full Text PDF Editorial by Lee, T. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Cardiovascular complications are the most important causes of perioperative morbidity and mortality among patients undergoing major vascular surgery.

Methods We performed a randomized, multicenter trial to assess the effect of perioperative blockade of beta-adrenergic receptors on the incidence of death from cardiac causes and nonfatal myocardial infarction within 30 days after major vascular surgery in patients at high risk for these events. High-risk patients were identified by the presence of both clinical risk factors and positive results on dobutamine echocardiography. Eligible patients were randomly assigned to receive standard perioperative care or standard care plus perioperative beta-blockade with bisoprolol.

Results A total of 1351 patients were screened, and 846 were found to have one or more cardiac risk factors. Of these 846 patients, 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 excluded from randomization because they were already taking a beta-blocker, and eight were excluded because they had extensive wall-motion abnormalities either at rest or during stress testing. Two patients in the bisoprolol group died of cardiac causes (3.4 percent), as compared with nine patients in the standard-care group (17 percent, P=0.02). Nonfatal myocardial infarction occurred in nine patients given standard care only (17 percent) and in none of those given standard care plus bisoprolol (P<0.001). Thus, the primary study end point of death from cardiac causes or nonfatal myocardial infarction occurred in 2 patients in the bisoprolol group (3.4 percent) and 18 patients in the standard-care group (34 percent, P<0.001).

Conclusions Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in 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.

Full Text of this Article

Related Letters:

Beta-Blockade for Patients Undergoing Vascular Surgery
Feldman T., Fusman B., McKinsey J. F., Litwack R. S., Gilligan D. M., DeGruttola V., Poldermans D., Boersma E., Thomson I. R., Lee T. H.
Extract | Full Text  
N Engl J Med 2000; 342:1051-1053, Apr 6, 2000. Correspondence

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