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Reducing perioperative myocardial infarction following vascular surgery. The potential role of beta-blockade
R A Yeager1, G L Moneta, J M Edwards
1Department of Surgery, Oregon Health Sciences University, Portland, USA.
Objective:
To determine which perioperative variables may influence the occurrence of perioperative myocardial infarction (PMI) following vascular surgery.
Design:
Case-control study.
Setting:
Combined Veterans Affairs Medical Center-university hospital vascular service.
Patients:
During a 4-year period, all major vascular surgical operations (N = 2088) were evaluated with serial postoperative electrocardiography and cardiac enzyme measurements. Patients with PMI following nonemergent vascular surgery (N = 53) were matched with randomly selected control patients without PMI (N = 106) for age, gender, type of operation, hypertension, and symptoms of coronary artery disease.
Main Outcome Measures:
The two groups were compared for operative blood loss, blood pressure, and heart rate as well as length of operation, type of anesthetic, and use of perioperative beta-blockers, nitroglycerine, calcium channel blockers, vasopressors, and angiotensin-converting enzyme inhibitors.
Results:
beta-Blockers were used less frequently in patients with PMI than in control patients without PMI (30% vs 50%; P = .01). Overall beta-blockade was associated with a 50% reduction in PMI (P = .03). Perioperative myocardial infarction was not associated with length of operation, type of anesthetic, blood pressure, or use of other medications.
Conclusions:
beta-Blockade is associated with a decreased incidence of PMI in patients undergoing vascular surgery. Prophylactic perioperative use of beta-blockers may decrease PMI in patients requiring major vascular surgery. A prospective randomized trial of beta-blockers in these patients appears to be warranted.