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
| Autor: | Hero van Urk, Jos R.T.C. Roelandt, Eric Boersma, Don Poldermans, Giuseppe Trocino, Jeroen J. Bax, H. F. Baars, Miklos D. Kertai, Maarten J. Cramer, M. G. Scheffer, Louis L. M. van de Ven, Ian R. Thomson, Carlo Vigna |
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| Přispěvatelé: | Cardiology, Surgery |
| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty Dobutamine stress echocardiography medicine.medical_treatment Adrenergic beta-Antagonists Ischemia Coronary Disease Preoperative care Risk Factors Internal medicine Internal Medicine medicine Humans Myocardial infarction Postoperative Period Vascular Diseases Aged Chemotherapy business.industry Vascular surgery medicine.disease Circulatory system Multivariate Analysis Cardiology Female Complication business Vascular Surgical Procedures Echocardiography Stress |
| Zdroj: | Archives of Internal Medicine, 163, 2230-2235. American Medical Association |
| ISSN: | 0003-9926 |
| Popis: | Background: Survivors of major vascular surgery are at increased risk of late cardiac complications. Objective: To examine the cardioprotective effect of β-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 β-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, β-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 β-blockers, the risk decreased to 7.2%. In patients with 3 or more risk factors, DSE and β-blockers stratified patients into intermediate- and high-risk groups. In patients without ischemia, β-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 β-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. |
| Databáze: | OpenAIRE |
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