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Optimizing Long-Term Cardiac Management After Major Vascular Surgery: Role of ß-Blocker Therapy, Clinical Characteristics, and Dobutamine Stress Echocardiography to Optimize Long-Term Cardiac Management After Major Vascular Surgery

G. Patrick Clagett, MD

Division of Vascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

The cardioprotective effects of ß-blockers were examined in 1286 participants who had survived major vascular surgery for at least 30 days. Patients were selected based on cardiac risk factors and results from dobutamine stress echocardiography. Dobutamine stress echocardiography was performed on 1034 patients and 370 patients received ß-blockers. Late cardiac events occurred in 74 patients; the rate in patients with three or more risk factors was 19.2%; for one to two factors it was 4.7%, and for 0 factors it was 1.6%. An improved event-free survival was noted in patients without risk factors who received ß-blockers; dobutamine stress echocardiography had no additional prognostic value. The presence of ischemia during dobutamine stress echocardiography increased cardiac events from 3.9% to 9.8% in patients with 1 to 2 risk factors; but if they received ß-blockers, the risk decreased to 7.2%. Dobutamine stress echocardiography and ß-blockers stratified patients with 3 or more risk factors into intermediate-and high-risk groups. The cardiac event rate dropped from 15.1% to 9.5% in patients without ischemia who were on ß-blocker therapy. If dobutamine stress echocardiography resulted in positive findings in a patient with 3 or more risk factors, the cardioprotective effect from ß-blockers was limited. The authors concluded that long-term ß-blocker use is associated with reduced cardiac event rates, except in patients with three or more risk factors and positive DSE findings.

Key Words: ischemia • dobutamine stress echocardiography • vascular surgery • ß-blockers

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