REDUCING PERIOPERATIVE MYOCARDIAL-INFARCTION FOLLOWING VASCULAR-SURGERY - THE POTENTIAL ROLE OF BETA-BLOCKADE

Objective: To determine which perioperative variables may influence th e occurrence of perioperative myocardial infarction (PMI) following va scular surgery. Design: Case-contol study. Setting: Combined Veterans Affairs Medical Center-university hospital vascular service. Patients: During a 4-year period, all major vascular surgical operations (N=208 8) were evaluated with serial postoperative electrocardiography and ca rdiac enzyme measurements. Patients with PMI following nonemergent vas cular surgery (N=53) were matched with randomly selected control patie nts without PMI (N=106) for age, gender, type of operation, hypertensi on, and symptoms of coronary artery disease. Main Outcome Measures: Th e two groups were compared for operative blood loss, blood pressure, a nd heart rate as well as length of operation, type of anesthetic, and use of perioperative beta-blockers, nitroglycerine, calcium channel bl ockers, vasopressors, and angiotensin-converting enzyme inhibitors. Re sults: beta-Blockers were used less frequently in patients with PMI th an in control patients without PMI (30% vs 50%; P=.01). Overall beta-b lockade was associated with a 50% reduction in PMI (P=.03). Perioperat ive myocardial infarction was not associated with length of operation, type of anesthetic, blood pressure, or use of other medications. Conc lusions: beta-Blockade is associated with a decreased incidence of PMI in patients undergoing vascular surgery. Prophylactic perioperative u se of beta-blockers may decrease PMI in patients requiring major vascu lar surgery. A prospective randomized trial of beta-blockers in these patients appears to be warranted.