Reducing Perioperative Myocardial Infarction Following Vascular Surgery

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Abstract
Objective: To determine which perioperative variables may influence the occurrence of perioperative myocardial infarction (PMI) following vascular surgery. Design: Case-contol study. Setting: Combined Veterans Affairs Medical Centeruniversity hospital vascular service. Patients: During a 4-year period, all major vascular surgical operations (N=2088) were evaluated with serial postoperative electrocardiography and cardiac enzyme measurements. Patients with PMI following nonemergent vascular surgery (N=53) were matched with randomly selected control patients without PMI (N=106) for age, gender, type of operation, hypertension, and symptoms of coronary artery disease. Main Outcome Measures: The two groups were compared for operative blood loss, blood pressure, and heart rate as well as length of operation, type of anesthetic, and use of perioperative β-blockers, nitroglycerine, calcium channel blockers, vasopressors, and angiotensinconverting enzyme inhibitors. Results: β-Blockers were used less frequently in patients with PMI than in control patients without PMI (30% vs 50%;P=.01). Overall β-blockade was associated with a 50% reduction in PMI (P=.03). Perioperative myocardial infarction was not associated with length of operation, type of anesthetic, blood pressure, or use of other medications. Conclusions: β-Blockade is associated with a decreased incidence of PMI in patients undergoing vascular surgery. Prophylactic perioperative use of β-blockers may decrease PMI in patients requiring major vascular surgery. A prospective randomized trial of β-blockers in these patients appears to be warranted. (Arch Surg. 1995;130:869-873)