The Effect of Bisoprolol on Perioperative Mortality and Myocardial Infarction in High-Risk Patients Undergoing Vascular Surgery

Abstract

Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

“…12 These recommendations stem from the demonstration that perioperative treatment with betablockers decreased the incidence of cardiac complications and death in very high-risk vascular surgery patients. 13 Conversely, recent studies reporting the effects of preoperative beta-blockers on outcomes after non-cardiac (including vascular) surgery produced controversial results [14][15][16][17] and could not demonstrate risk reduction. The results of a meta-analysis after these trials suggested an increase in postoperative stroke.…”

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

“…2). When both mortality and morbidity data are considered, cardiac events occur in an estimated 1-5% of patients undergoing non-cardiac surgery, and the cardiovascular complication rate may reach 30% for patients undergoing vascular surgery 5,6 . In recent years the introduction of troponin assay for the diagnosis of perioperative MI [7][8][9][10][11][12][13][14] led to an apparent further increase in the frequency of perioperative MI from 1.4% with creatine kinase-MB assay to 6.6% 11 .…”

“…On the basis of two studies 5,80 , the ACC/AHA task force on guidelines for non-cardiac surgery recommended perioperative beta-blockers for patients with preoperative stress test ischaemia having vascular surgery (class I recommendation) and for patients with established CAD, risk factors for CAD, or untreated hypertension having non-cardiac surgery (class IIa recommendation) 32 . In these two major studies, preoperative administration of beta-blockers titrated to a dose to achieve a resting heart rate of 50-60 bpm showed favourable effects on perioperative MI in high-risk patients undergoing major vascular surgery 5,80 .…”

“…In these two major studies, preoperative administration of beta-blockers titrated to a dose to achieve a resting heart rate of 50-60 bpm showed favourable effects on perioperative MI in high-risk patients undergoing major vascular surgery 5,80 .…”

“…When the six deaths that occurred during the period when patients received the study drug are appropriately included in the intention-to-treat analysis, the reduction in the risk of death with atenolol is no longer significant. The second study evaluated the effect on 1-month mortality in patients with positive dobutamine stress echo who were not already on beta-blockers 5 . In particular, any patient with a risk factor (age > 70 years; angina; prior MI on the basis of history or a finding of pathologic Q waves on electrocardiography; compensated congestive heart failure or a history of congestive heart failure; current treatment for ventricular arrhythmias; current treatment for diabetes mellitus; or limited exercise capacity, defined as the inability to perform most normal daily activities) underwent dobutamine echocardiography.…”