High-dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients.
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.
Feringa
Harm H H
HH
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, Netherlands.
Bax
Jeroen J
JJ
Boersma
Eric
E
Kertai
Miklos D
MD
Meij
Simon H
SH
Galal
Wael
W
Schouten
Olaf
O
Thomson
Ian R
IR
Klootwijk
Peter
P
van Sambeek
Marc R H M
MR
Klein
Jan
J
Poldermans
Don
D
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
D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D020107:Troponin T