Author + information
- Received March 16, 2010
- Revision received May 10, 2010
- Accepted May 11, 2010
- Published online November 30, 2010.
- Willem-Jan Flu, MD*,
- Jan-Peter van Kuijk, MD*,
- Michel Chonchol, MD†,
- Tamara A. Winkel, MD‡,
- Hence J.M. Verhagen, MD‡,
- Jeroen J. Bax, MD§ and
- Don Poldermans, MD‡,* ()
- ↵*Reprint requests and correspondence:
Dr. Don Poldermans, Department of Vascular Surgery of the Erasmus Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands
Objectives This study evaluated timing of β-blocker initiation before surgery and its relationship with: 1) pre-operative heart rate and high-sensitivity C-reactive-protein (hs-CRP) levels; and 2) post-operative outcome.
Background Perioperative guidelines recommend β-blocker initiation days to weeks before surgery, on the basis of expert opinions.
Methods In 940 vascular surgery patients, pre-operative heart rate and hs-CRP levels were recorded, next to timing of β-blocker initiation before surgery (0 to 1, >1 to 4, >4 weeks). Pre- and post-operative troponin-T measurements and electrocardiograms were performed routinely. End points were 30-day cardiac events (composite of myocardial infarction and cardiac mortality) and long-term mortality. Multivariate regression analyses, adjusted for cardiac risk factors, evaluated the relation between duration of β-blocker treatment and outcome.
Results The β-blockers were initiated 0 to 1, >1 to 4, and >4 weeks before surgery in 158 (17%), 393 (42%), and 389 (41%) patients, respectively. Median heart rate at baseline was 74 (±17) beats/min, 70 (±16) beats/min, and 66 (±15) beats/min (p < 0.001; comparing treatment initiation >1 with <1 week pre-operatively), and hs-CRP was 4.9 (±7.5) mg/l, 4.1 (±.6.0) mg/l, and 4.5 (±6.3) mg/l (p = 0.782), respectively. Treatment initiated >1 to 4 or >4 weeks before surgery was associated with a lower incidence of 30-day cardiac events (odds ratio: 0.46, 95% confidence interval [CI]: 0.27 to 0.76, odds ratio: 0.48, 95% CI: 0.29 to 0.79) and long-term mortality (hazard ratio: 0.52, 95% CI: 0.21 to 0.67, hazard ratio: 0.50, 95% CI: 0.25 to 0.71) compared with treatment initiated <1 week pre-operatively.
Conclusions Our results indicate that β-blocker treatment initiated >1 week before surgery is associated with lower pre-operative heart rate and improved outcome, compared with treatment initiated <1 week pre-operatively. No reduction of median hs-CRP levels was observed in patients receiving β-blocker treatment >1 week compared with patients in whom treatment was initiated between 0 and 1 week before surgery.
Drs. Flu, van Kuijk, and Winkel were supported by an unrestricted research grant from “Lijf en Leven” Rotterdam, the Netherlands. All other authors have reported that they have no relationships to disclose.
- Received March 16, 2010.
- Revision received May 10, 2010.
- Accepted May 11, 2010.
- American College of Cardiology Foundation