Reducing perioperative myocardial infarction following vascular surgery. The potential role of beta-blockade.
OBJECTIVE
To determine which perioperative variables may influence the occurrence of perioperative myocardial infarction (PMI) following vascular surgery.


METHODS
Case-control study.


METHODS
Combined Veterans Affairs Medical Center-university hospital vascular service.


METHODS
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.


METHODS
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.
Yeager
R A
RA
Department of Surgery, Oregon Health Sciences University, Portland, USA.
Moneta
G L
GL
Edwards
J M
JM
Taylor
L M
LM
McConnell
D B
DB
Porter
J M
JM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D016022:Case-Control Studies; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000201:enzymology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D000319:Adrenergic beta-Antagonists; D007527:Isoenzymes; D003402:Creatine Kinase