Bisoprolol and Fluvastatin for the Reduction of Perioperative Cardiac Mortality and Myocardial Infarction in Intermediate-Risk Patients Undergoing Noncardiovascular Surgery

Dunkelgrün, Martin; Boersma, Eric; Schouten, Olaf; Gemert, A.W.M.M. Koopman-van; Poorten, Frans van; Bax, Jeroen J.; Thomson, Ian R.; Poldermans, Don

doi:10.1097/sla.0b013e3181a77d00

Cited by 278 publications

(158 citation statements)

References 34 publications

Supporting

Mentioning

128

Contrasting

Unclassified

Order By: Relevance

“…27) Many trials have sought prognosticating factors in noncardiac surgery. 4,5,6,10,21,22,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] In these studies, poor functional capacity, recent MI and unstable angina, decompensated heart failure, significant arrhythmia, diabetes mellitus, renal insufficiency, cerebrovascular disease, advanced age, tachycardia, anemia, surgical kind, and elevated troponin-I level were determined to be independent prognostic factors after noncardiac surgery, most of which were in agreement with our study. While the results of those studies had been generated after short-term follow-up, the present study extended the follow-up period to 7 years and attempted to provide valuable data regarding longer term mortality.…”

Section: )supporting

confidence: 77%

Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality

et al. 2016

View full text Add to dashboard Cite

SummaryIndividuals with intermediate to high cardiac risk for major noncardiac surgery suffer from perioperative myocardial ischemic injury. The purpose of this study was to evaluate the long-term impact of postoperative cardiac troponin elevation on clinical outcome after major noncardiac surgery.Patients (n = 750) aged ≥ 50 years who underwent major noncardiac surgery were eligible for the study. Postoperative cardiac troponin-I data were collected retrospectively and consecutively. The primary outcome measure was allcause mortality. The median follow-up period was 1727 days in all patients.Among 750 patients, 92 (12.2%) showed elevated postoperative troponin-I above 0.10 ng/mL. Operative mortality was 4.1% (31 subjects), and patients with troponin-I elevation showed a higher operative mortality rate (RR: 4.23, 95% CI: 2.67-11.31, P < 0.001). In multivariate Cox regression analysis, a troponin-I concentration above 0.10 ng/mL was associated with all-cause mortality (RR: 1.73, 95% CI: 1.27-2.36, P < 0.001). It should be noted that there was a significant difference between patients with elevated and non-elevated troponin-I in the rate of mortality until 6 months. However, these differences disappeared after 6 months. An elevated troponin-I level conferred an increase in mortality during the 7 year follow-up period after major noncardiac surgery. This difference in mortality was mainly derived from the result within the first 6 months. (Int Heart J 2016; 57: 278-284) Key words: Myocardial ischemia, Death, Surgical procedures A ll surgical procedures elicit a stress response, although the extent of the response depends on the extent of the surgery and the use of anesthetics and analgesics that are used to reduce the response. The stress response can lead to increases in heart rate and blood pressure, which can precipitate episodes of myocardial ischemia. 1)Individuals with intermediate to high cardiac risk for noncardiac surgery suffer from perioperative myocardial ischemic injury.2) Cardiac troponins are a useful tool that help clinicians in making the diagnosis of perioperative myocardial infarction.3-5) Many previous studies have investigated the role of cardiac troponins in the diagnosis of perioperative myocardial ischemic events and demonstrated the prognostic value of postoperative cardiac troponin elevation.6-9) A recent metaanalysis of studies in predominantly high-risk surgery patients also showed that cardiac troponin elevation was a strong independent predictor of mortality within the first year after surgery. 10) Editorial p.265The development of perioperative cardiovascular complications not only affects the short-term period prognosis but may also influence the long-term consequences. However, few studies have explored the long-term, defined as beyond the first year after major noncardiac surgery, prognostic value of cardiac troponin elevation in the prediction of postoperative outcome. We undertook this study to evaluate the clinical outcome of cardiac troponin elevation after major noncardiac sur...

show abstract

Section: )supporting

confidence: 77%

Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality

et al. 2016

View full text Add to dashboard Cite

show abstract

“…[15][16][17] Nevertheless, it was likely apparent to the ACCF/AHA group that there is insufficient evidence to date for implementation of this potentially expensive and logistically complex process in the United States with its ''diverse'' health care system (complicated by the lack of substantial data from studies conducted in the United States). In all probability, this factor accounts for the lack of any new Class 1 recommendations.…”

mentioning

confidence: 99%

“…This approach to the pharmacokinetics and dynamics of beta blockade is based on a limited number of perioperative studies by the Poldermans group in which institution of low doses of bisoprolol within a window of 30 days to 1 week prior to surgery is promoted (all of which attest to its apparent safety). [15][16][17] The ESC group specifically recommends starting doses of either 2.5 mg of bisoprolol or 50 mg of metoprolol succinate, while the ACCF/AHA group makes no specific drug recommendation (perhaps recognizing the popularity of atenolol or the cost-effectiveness of metoprolol tartrate). The ESC group is more explicit in its recommendation to titrate the dose of either drug to maintain a resting heart rate of 60-70 beatsÁmin -1 , while the ACCF/AHA group has liberalized its earlier recommendations of [60][61][62][63][64][65] New practice guidelines for perioperative beta blockade from the United States and Europe 303…”

mentioning

confidence: 99%

“…Ce protocole serait efficace chez divers groupes de patients médicaux et chirurgicaux. [15][16][17] Néanmoins, il est probable que le groupe de l'ACCF/AHA se soit rendu compte que les données probantes actuelles étaient insuffisantes pour justifier la mise en oeuvre d'un tel processus aux É tats-Unis, étant donné son coût potentiellement élevé et sa complexité logistique aux É tats-Unis, un pays au système de soins de santé « diversifié » (le manque de données d'envergure tirées d'études menées aux É tats-Unis compliquant encore la donne). Selon toute probabilité, ce facteur est à l'origine de l'absence de nouvelles recommandations de classe I.…”

unclassified

“…Cette approche de la pharmacocinétique et de la dynamie du bêta-blocage se fonde sur un nombre restreint d'études périopératoires de Poldermans et coll., dans lesquelles l'introduction de faibles doses de bisoprolol est recommandée dans une fenêtre de 30 jours à une semaine avant la chirurgie (toutes les études font état de l'apparente innocuité du médicament). [15][16][17] Le groupe de l'ESC recommande spécifiquement des doses initiales de 2,5 mg de bisoprolol ou 50 mg de succinate de métoprolol, alors que le groupe de l'ACCF/AHA n'émet pas de recommandation médicamenteuse spécifique (reconnaissant peut-être la popularité de l'aténolol ou la rentabilité du tartrate de métoprolol). Le groupe ESC est plus explicite dans sa recommandation de titrer la dose de l'un ou l'autre médicament afin de maintenir une fréquence cardiaque au repos de 60-70 battementsÁmin -1 , alors que le groupe de l'ACCF/AHA a assoupli ses recommandations précédentes de 60-65 battementsÁmin -1 à 60-80 battementsÁmin -1 .…”

unclassified

See 2 more Smart Citations

New practice guidelines for perioperative beta blockade from the United States and Europe: incremental progress or a necessary evil?

London

2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Effect of Perioperative Statins on Death, Myocardial Infarction, Atrial Fibrillation, and Length of Stay

Chopra¹

2012

Arch Surg

113

View full text Add to dashboard Cite

Objective: To assess the influence of perioperative statin treatment on the risk of death, myocardial infarction, atrial fibrillation, and hospital and intensive care unit length of stay in statin-naive patients undergoing cardiac or noncardiac surgery. Data Sources: MEDLINE via PubMed, EMBASE, Biosis, and the Cochrane Central Register of Controlled Trials via Ovid. Additional studies were identified through hand searches of bibliographies, trial Web sites, and clinical experts. Randomized controlled trials reporting the effect of perioperative statins in statin-naive patients undergoing cardiac and noncardiac surgery were included. Study Selection: Two investigators independently selected eligible studies from original research published in any language studying the effects of statin use on perioperative outcomes of interest. Data Extraction: Two investigators performed independent article abstraction and quality assessment. Data Synthesis: Fifteen randomized controlled studies involving 2292 patients met the eligibility criteria.Random-effects meta-analyses of unadjusted and adjusted data were performed according to the method described by DerSimonian and Laird. Perioperative statin treatment decreased the risk of atrial fibrillation in patients undergoing cardiac surgery (relative risk [RR], 0.56; 95% CI, 0.45 to 0.69; number needed to treat [NNT], 6). In cardiac and noncardiac surgery, perioperative statin treatment reduced the risk of myocardial infarction (RR, 0.53; 95% CI, 0.38 to 0.74; NNT, 23) but not the risk of death (RR, 0.62; 95% CI, 0.34 to 1.14). Statin treatment reduced mean length of hospital stay (standardized mean difference, −0.32; 95% CI, −0.53 to −0.11) but had no effect on length of intensive care unit stay (standardized mean difference, −0.08; 95% CI, −0.25 to 0.10).Conclusions: Perioperative statin treatment in statinnaive patients reduces atrial fibrillation, myocardial infarction, and duration of hospital stay. Wider use of statins to improve cardiac outcomes in patients undergoing high-risk procedures seems warranted.

show abstract

Bisoprolol and Fluvastatin for the Reduction of Perioperative Cardiac Mortality and Myocardial Infarction in Intermediate-Risk Patients Undergoing Noncardiovascular Surgery

Abstract: Bisoprolol was associated with a significant reduction of 30-day cardiac death and nonfatal MI, while fluvastatin showed a trend for improved outcome.

Cited by 278 publications

References 34 publications

Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality

Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality

New practice guidelines for perioperative beta blockade from the United States and Europe: incremental progress or a necessary evil?

Effect of Perioperative Statins on Death, Myocardial Infarction, Atrial Fibrillation, and Length of Stay

Contact Info

Product

Resources

About