A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery.
OBJECTIVE
To investigate the combined beneficial effect of statin and beta-blocker use on perioperative mortality and myocardial infarction (MI) in patients undergoing abdominal aortic aneurysm surgery (AAA).


BACKGROUND
Patients undergoing elective AAA-surgery identified by clinical risk factors and dobutamine stress echocardiography (DSE) as being at high-risk often have considerable cardiac complication rate despite the use of beta-blockers.


METHODS
We studied 570 patients (mean age 69+/-9 years, 486 males) who underwent AAA-surgery between 1991 and 2001 at the Erasmus MC. Patients were evaluated for clinical risk factors (age>70 years, histories of MI, angina, diabetes mellitus, stroke, renal failure, heart failure and pulmonary disease), DSE, statin and beta-blocker use. The main outcome was a composite of perioperative mortality and MI within 30 days of surgery.


RESULTS
Perioperative mortality or MI occurred in 51 (8.9%) patients. The incidence of the composite endpoint was significantly lower in statin users compared to nonusers (3.7% vs. 11.0%; crude odds ratio (OR): 0.31, 95% confidence interval (CI): 0.13-0.74; p=0.01). After correcting for other covariates, the association between statin use and reduced incidence of the composite endpoint remained unchanged (OR: 0.24, 95% CI: 0.10-0.70; p=0.01). Beta-blocker use was also associated with a significant reduction in the composite endpoint (OR: 0.24, 95% CI: 0.11-0.54). Patients using a combination of statins and beta-blockers appeared to be at lower risk for the composite endpoint across multiple cardiac risk strata; particularly patients with 3 or more risk factors experienced significantly lower perioperative events.


CONCLUSIONS
A combination of statin and beta-blocker use in patients with AAA-surgery is associated with a reduced incidence of perioperative mortality and nonfatal MI particularly in patients at the highest risk.
Kertai
M D
MD
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Boersma
E
E
Westerhout
C M
CM
Klein
J
J
Van Urk
H
H
Bax
J J
JJ
Roelandt
J R T C
JR
Poldermans
D
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D004359:Drug Therapy, Combination; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D009426:Netherlands / Q000453:epidemiology; D019990:Perioperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors