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Reducing Perioperative Myocardial Infarction Following Vascular SurgeryThe Potential Role of β-Blockade
Richard A. Yeager, MD;
Gregory L. Moneta, MD;
James M. Edwards, MD;
Lloyd M. Taylor, Jr, MD;
Donald B. McConnell, MD;
John M. Porter, MD
Arch Surg. 1995;130(8):869-873.
Abstract
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Objective
To determine which perioperative variables may influence the occurrence of perioperative myocardial infarction (PMI) following vascular surgery.
Design
Case-contol study.
Setting
Combined Veterans Affairs Medical Centeruniversity hospital vascular service.
Patients
During a 4-year period, all major vascular surgical operations (N=2088) were evaluated with serial postoperative electrocardiography and cardiac enzyme measurements. Patients with PMI following nonemergent vascular surgery (N=53) were matched with randomly selected control patients without PMI (N=106) for age, gender, type of operation, hypertension, and symptoms of coronary artery disease.
Main Outcome Measures
The two groups were compared for operative blood loss, blood pressure, and heart rate as well as length of operation, type of anesthetic, and use of perioperative β-blockers, nitroglycerine, calcium channel blockers, vasopressors, and angiotensinconverting enzyme inhibitors.
Results
β-Blockers were used less frequently in patients with PMI than in control patients without PMI (30% vs 50%; P=.01). Overall β-blockade was associated with a 50% reduction in PMI (P=.03). Perioperative myocardial infarction was not associated with length of operation, type of anesthetic, blood pressure, or use of other medications.
Conclusions
β-Blockade is associated with a decreased incidence of PMI in patients undergoing vascular surgery. Prophylactic perioperative use of β-blockers may decrease PMI in patients requiring major vascular surgery. A prospective randomized trial of β-blockers in these patients appears to be warranted.
(Arch Surg. 1995;130:869-873)
Author Affiliations
From the Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences University, Portland, and Portland Veterans Affairs Medical Center.
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