OBJECTIVE: Our purpose was to determine the effect of postoperative beta-blocker withdrawal on mortality and cardiovascular events after vascular surgery. METHODS: Detailed data were collected on perioperative cardiovascular medication use and discontinuation and cardiovascular risk factors among consecutive major vascular surgical procedures at two university hospitals. RESULTS: A total of 140 patients received beta-blockers preoperatively. Mortality in the 8 patients who had beta-blockers discontinued postoperatively (50%) was significantly greater than in 132 patients who had beta-blockers continued (1.5%, odds ratio 65.0, P<.001). The effect of beta-blocker discontinuation was unaffected by adjustment by stratification for risk factors (all P< or =.01), for contraindications to restarting beta-blockers (P = .006), and by multivariable analyses adjusting for potential confounders (adjusted odds ratio 17.0, P =.01). beta-Blocker discontinuation also was associated with increased cardiovascular mortality (0% vs 29%, P =.005) and postoperative myocardial infarction (odds ratio 17.7, P =.003). CONCLUSION: Discontinuing beta-blockers immediately after vascular surgery may increase the risk of postoperative cardiovascular morbidity and mortality.
OBJECTIVE: Our purpose was to determine the effect of postoperative beta-blocker withdrawal on mortality and cardiovascular events after vascular surgery. METHODS: Detailed data were collected on perioperative cardiovascular medication use and discontinuation and cardiovascular risk factors among consecutive major vascular surgical procedures at two university hospitals. RESULTS: A total of 140 patients received beta-blockers preoperatively. Mortality in the 8 patients who had beta-blockers discontinued postoperatively (50%) was significantly greater than in 132 patients who had beta-blockers continued (1.5%, odds ratio 65.0, P<.001). The effect of beta-blocker discontinuation was unaffected by adjustment by stratification for risk factors (all P< or =.01), for contraindications to restarting beta-blockers (P = .006), and by multivariable analyses adjusting for potential confounders (adjusted odds ratio 17.0, P =.01). beta-Blocker discontinuation also was associated with increased cardiovascular mortality (0% vs 29%, P =.005) and postoperative myocardial infarction (odds ratio 17.7, P =.003). CONCLUSION: Discontinuing beta-blockers immediately after vascular surgery may increase the risk of postoperative cardiovascular morbidity and mortality.
Authors: Anne Benedicte Juul; Jørn Wetterslev; Christian Gluud; Allan Kofoed-Enevoldsen; Gorm Jensen; Torben Callesen; Peter Nørgaard; Kim Fruergaard; Morten Bestle; Rune Vedelsdal; André Miran; Jon Jacobsen; Jakob Roed; Maj-Britt Mortensen; Lise Jørgensen; Jørgen Jørgensen; Marie-Louise Rovsing; Pernille Lykke Petersen; Frank Pott; Merete Haas; Rikke Albret; Lise Lotte Nielsen; Gun Johansson; Pia Stjernholm; Yvonne Mølgaard; Nikolai Bang Foss; Jeanie Elkjaer; Bjørn Dehlie; Klavs Boysen; Dusanka Zaric; Anne Munksgaard; Jørn Bo Madsen; Bjarne Øberg; Boris Khanykin; Tine Blemmer; Stig Yndgaard; Grazyna Perko; Lars Peter Wang; Per Winkel; Jørgen Hilden; Per Jensen; Nader Salas Journal: BMJ Date: 2006-06-24
Authors: Lee A Fleisher; Kirsten E Fleischmann; Andrew D Auerbach; Susan A Barnason; Joshua A Beckman; Biykem Bozkurt; Victor G Davila-Roman; Marie D Gerhard-Herman; Thomas A Holly; Garvan C Kane; Joseph E Marine; M Timothy Nelson; Crystal C Spencer; Annemarie Thompson; Henry H Ting; Barry F Uretsky; Duminda N Wijeysundera Journal: J Nucl Cardiol Date: 2015-02 Impact factor: 5.952
Authors: T Zaglavara; R Haaverstad; B Cumberledge; T Irvine; H Karvounis; G Parharidis; G Louridas; A Kenny Journal: Heart Date: 2002-04 Impact factor: 5.994
Authors: Steve Kwon; Rachel Thompson; Michael Florence; Ronald Maier; Lisa McIntyre; Terry Rogers; Ellen Farrohki; Mark Whiteford; David R Flum Journal: Arch Surg Date: 2012-05