Predictors of Cardiac Events After Major Vascular Surgery Role of Clinical Characteristics, Dobutamine Echocardiography, and -Blocker Therapy
ORIGINAL CONTRIBUTION Predictors of Cardiac Events After Major Vascular Surgery Role of Clinical Characteristics, Dobutamine Echocardiography, and b-Blocker Therapy Eric Boersma, PhD Context Patients who undergo major vascular surgery are at increased risk of peri- Don Poldermans, MD, PhD operative cardiac complications. High-risk patients can be identified by clinical factors and noninvasive cardiac testing, such as dobutamine stress echocardiography (DSE); Jeroen J. Bax, MD, PhD however, such noninvasive imaging techniques carry significant disadvantages. A re- Ewout W. Steyerberg, MD, PhD cent study found that perioperative b-blocker therapy reduces complication rates in Ian R. Thomson, MD high-risk individuals. Objective To examine the relationship of clinical characteristics, DSE results, b-blocker Jan D. Banga, MD, PhD therapy, and cardiac events in patients undergoing major vascular surgery. Louis L. M. van de Ven, MD, PhD Design and Setting Cohort study conducted in 1996-1999 in the following 8 cen- Hero van Urk, MD, PhD ters: Erasmus Medical Centre and Sint Clara Ziekenhuis, Rotterdam, Twee Steden Ziek- enhuis, Tilburg, Academisch Ziekenhuis Utrecht, Utrecht, and Medisch Centrum Alkmaar, Jos R. T. C. Roelandt, MD, PhD Alkmaar, the Netherlands; Ziekenhuis Middelheim, Antwerp, Belgium; and San Gerardo for the DECREASE Study Group Hospital, Monza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy. ATIENTS WITH SEVERE PERIPH- Patients A total of 1351 consecutive patients scheduled for major vascular surgery; eral vascular disease frequently b have underlying coronary artery DSE was performed in 1097 patients (81%), and 360 (27%) received -blocker therapy. disease. Hence, patients under- Main Outcome Measure Cardiac death or nonfatal myocardial infarction within 30 b Pgoing major vascular surgery are at days after surgery, compared by clinical characteristics, DSE results, and -blocker use.
[Show full text]