title: High-dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients.
abstract: BACKGROUND
  Adverse perioperative cardiac events occur frequently despite the use of beta (beta)-blockers. We examined whether higher doses of beta-blockers and tight heart rate control were associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome.
  
  
  RESULTS
  In an observational cohort study, 272 vascular surgery patients were preoperatively screened for cardiac risk factors and beta-blocker dose. Beta-blocker dose was converted to a percentage of maximum recommended therapeutic dose. Heart rate and ischemic episodes were recorded by continuous 12-lead electrocardiography, starting 1 day before to 2 days after surgery. Serial troponin T levels were measured after surgery. All-cause mortality was noted during follow-up. Myocardial ischemia was detected in 85 of 272 (31%) patients and troponin T release in 44 of 272 (16.2%). Long-term mortality occurred in 66 of 272 (24.2%) patients. In multivariate analysis, higher beta-blocker doses (per 10% increase) were significantly associated with a lower incidence of myocardial ischemia (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.51 to 0.75), troponin T release (HR, 0.63; 95% CI, 0.49 to 0.80), and long-term mortality (HR, 0.86; 95% CI, 0.76 to 0.97). Higher heart rates during electrocardiographic monitoring (per 10-bpm increase) were significantly associated with an increased incidence of myocardial ischemia (HR, 2.49; 95% CI, 1.79 to 3.48), troponin T release (HR, 1.53; 95% CI, 1.16 to 2.03), and long-term mortality (HR, 1.42; 95% CI, 1.14 to 1.76).
  
  
  CONCLUSIONS
  This study showed that higher doses of beta-blockers and tight heart rate control are associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome in vascular surgery patients.
authors.affiliation: Department of Anesthesiology, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Harm H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Miklos D
authors.initials: MD
authors.lastname: Kertai
authors.forename: Simon H
authors.initials: SH
authors.lastname: Meij
authors.forename: Wael
authors.initials: W
authors.lastname: Galal
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Ian R
authors.initials: IR
authors.lastname: Thomson
authors.forename: Peter
authors.initials: P
authors.lastname: Klootwijk
authors.forename: Marc R H M
authors.initials: MR
authors.lastname: van Sambeek
authors.forename: Jan
authors.initials: J
authors.lastname: Klein
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D025401:Echocardiography, Stress; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017202:Myocardial Ischemia / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D011184:Postoperative Period; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012306:Risk; D020107:Troponin T / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D020107:Troponin T