title: Optimizing long-term cardiac management after major vascular surgery: Role of beta-blocker therapy, clinical characteristics, and dobutamine stress echocardiography to optimize long-term cardiac management after major vascular surgery.
abstract: BACKGROUND
  Survivors of major vascular surgery are at increased risk of late cardiac complications.
  
  
  OBJECTIVE
  To examine the cardioprotective effect of beta-blockers.
  
  
  METHODS
  A follow-up study was conducted in 1286 patients who survived surgery for at least 30 days. Patients were screened for cardiac risk factors and dobutamine stress echocardiography (DSE) results; 1034 patients (80%) underwent preoperative DSE, and 370 (29%) received beta-blockers. The main outcome measure was late cardiac death or myocardial infarction.
  
  
  RESULTS
  Seventy-four patients (5.8%) had late cardiac events. Cardiac event rates in patients with 0, 1 to 2, and 3 or more risk factors were 1.6%, 4.7%, and 19.2%, respectively. In patients without risk factors, beta-blockers were associated with improved event-free survival (2.8% vs 0%), and DSE had no additional prognostic value. In patients with 1 to 2 risk factors, the presence of ischemia during DSE increased cardiac events from 3.9% to 9.8%. However, if patients with ischemia were treated with beta-blockers, the risk decreased to 7.2%. In patients with 3 or more risk factors, DSE and beta-blockers stratified patients into intermediate- and high-risk groups. In patients without ischemia, beta-blockers reduced the cardiac event rate from 15.1% to 9.5%, whereas the cardioprotective effect was limited in patients with 3 or more risk factors and positive DSE findings.
  
  
  CONCLUSIONS
  Long-term beta-blocker use is associated with a reduction in the cardiac event rate, except for patients with 3 or more risk factors and positive findings on DSE.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Miklos D
authors.initials: MD
authors.lastname: Kertai
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Ian R
authors.initials: IR
authors.lastname: Thomson
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Cramer
authors.forename: Louis L M
authors.initials: LL
authors.lastname: van de Ven
authors.forename: Michaël G
authors.initials: MG
authors.lastname: Scheffer
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trocino
authors.forename: Carlo
authors.initials: C
authors.lastname: Vigna
authors.forename: Hubert F
authors.initials: HF
authors.lastname: Baars
authors.forename: Hero
authors.initials: H
authors.lastname: van Urk
authors.forename: Jos R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011184:Postoperative Period; D012307:Risk Factors; D014652:Vascular Diseases / Q000453:epidemiology; D014656:Vascular Surgical Procedures
chemical_list: D000319:Adrenergic beta-Antagonists