Abstract 15238: The Impact of Aspirin, Beta-Blockers, Statins(T3), and Angiotensin Converting Enzyme-Inhibitors(ACE-I) for the Reduction of Perioperative and Long-Term Mortality in High Risk Patients Undergoing Major Vascular Surgery
Background: A combination of beta-blockers and statins independently reduced perioperative mortality and nonfatal myocardial infarction (MI) in patients undergoing vascular surgery. This study examined whether there is additional benefit of combining aspirin, beta-blockers, statins (T3), and ACE-I therapy on long-term mortality in high-risk patients undergoing major vascular surgery.
Methods: Epidemiologic analysis of adult patients underwent elective major vascular surgery since 2003 at the University of Michigan Health System was performed. These patients were evaluated for the use of perioperative aspirin (ASA), beta-blocker, statin, and ACE-I, and for clinical risk factors using the Revised Cardiac Risk Index (RCRI: coronary artery disease; insulin dependent diabetes mellitus; stroke; renal dysfunction; or heart failure) ≥ 3, and their association with the 12-month mortality. Since the decision for T3 and ACE-I therapy were not randomized, separate propensity scores were calculated by multiple logistic regression analyses to adjust for differences between nonrandomized groups.
Results: A total of 2053 vascular procedures with RCRI 1-5 were performed between January 2003 to December 2009. In patients meeting the criteria for RCRI ≥ 3 (n = 960), adjusting for propensities of receiving each of the 4 medications, ASA (odds ratio (OR): 0.29, 95% confidence interval (CI): 0.15-0.51, p<0.001), beta-blockers (OR: 0.24, 95% CI: 0.14-0.51, p<0.001), and statins (OR: 0.29, 95% CI: 0.17-0.49, p< 0.001) were independent predictors of improved survival at 12-months, but not ACE-I (OR: 0.73, 95% CI: 0.42-1.27, p=0.27), C = 0.82.
Conclusion: In high-risk patients undergoing major vascular surgery, combined ASA, beta blocker and statin therapy has superior 12-month risk reduction benefits for mortality as compared to independent benefits of beta-blockers, statins, or ASA alone. ACE-I did not demonstrate additional risk reduction benefits.
- © 2011 by American Heart Association, Inc.