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(Circulation. 2006;114:I-344 – I-349.)
© 2006 American Heart Association, Inc.

Surgery for Aortic and Peripheral Vascular Disease

High-Dose ß-Blockers and Tight Heart Rate Control Reduce Myocardial Ischemia and Troponin T Release in Vascular Surgery Patients

Harm H.H. Feringa, MD; Jeroen J. Bax, MD; Eric Boersma, PhD; Miklos D. Kertai, MD; Simon H. Meij, MSc; Wael Galal, MD; Olaf Schouten, MD; Ian R. Thomson, MD; Peter Klootwijk, MD; Marc R.H.M. van Sambeek, MD; Jan Klein, MD; Don Poldermans, MD

From the Department of Anesthesiology (H.H.H.F., M.D.K., W.G., J.K., D.P.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology (J.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology (S.H.M., P.K.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Vascular Surgery (O.S., M.R.H.M.v.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Anesthesiology (I.R.T.), University of Manitoba, Winnipeg, Canada.

Correspondence to D. Poldermans, Erasmus Medical Center, University of Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. E-mail d.poldermans{at}erasmusmc.nl

Background— Adverse perioperative cardiac events occur frequently despite the use of beta (ß)-blockers. We examined whether higher doses of ß-blockers and tight heart rate control were associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome.

Methods and Results— In an observational cohort study, 272 vascular surgery patients were preoperatively screened for cardiac risk factors and ß-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 ß-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).

Conclusion— This study showed that higher doses of ß-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.

Key Words: beta-blockers • heart rate • ischemia • surgery