Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery

Aim To assess the long-term cardioprotective effect of bisoprolol in a rand omized high-risk population after successful major vascular surgery. High-r isk patients were defined by the presence of one or more cardiac risk facto r(s) and a dobutamine echocardiography test positive for ischaemia. Methods 1351 patients were screened prior to surgery, 846 patients had one or more risk factor(s), and 173 of these patients also had ischaemia during dobutamine echocardiography. One hundred and twelve patients could be rand omized for additional bisoprolol therapy or standard care. Eleven patients died in the peri-operative period (up to 1 month after surgery). Randomized patients continued bisoprolol or standard care after surgery. During follo w-up of 101 survivors (median 22 months, range 11-30) cardiac death or myoc ardial infarction was noted. No patient was lost during follow-up. Results The incidence of cardiac events during follow-up in the bisoprolol group was 12% vs 32% in the standard care group (P=0.025). Cardiac death oc curred in 15 patients, nine patients in the standard care and in six in the bisoprolol group; myocardial infarction occurred in six patients, five in the standard care and one in the bisoprolol group. The odds ratio for cardi ac death or myocardial infarction after surgery in high-risk patients with additional bisoprolol therapy was 0.30 (0.11-0.83). Conclusions Bisoprolol significantly reduced long-term cardiac death and my ocardial infarction in high-risk patients after successful major cardiac va scular surgery.