β-Blockers improve in-hospital and long-term survival in patients with severe left ventricular dysfunction undergoing major vascular surgery

Objectives. To study whether β-blockers reduce in-hospital and long-term mortality in patients with severe left ventricular dysfunction (LVD) undergoing major vascular surgery. Design. Observational cohort study. Materials. Five hundred and eleven patients with severe LVD (ejection fraction<30%) undergoing major non-cardiac vascular surgery. Methods. In all patients, cardiac risk factors, medication (including β-blockers), and dobutamine stress echocardiography (DSE) results were noted prior to surgery. DSE was evaluated for rest and stress-induced new wall motion abnormalities. Endpoint was in-hospital and long-term mortality. Propensity scores for β-blockers were calculated and regression models were used to analyse the relation between β-blockers and mortality. Results. Mean age was 64± 11 years and 383 patients (75%) were male. 139 patients (27%) used β-blockers. Stress-induced ischemia occurred in 82 patients (16%). Median follow-up was 7 years (interquartile range: 3-10). In-hospital and long-term mortality was observed in 64 (13%) and 171 (33%) patients, respectively. After adjusting for clinical variables, DSE results and propensity scores, β-blockers were significantly associated with reduced in-hospital and long-term mortality (OR: 0.18, 95% CI: 0.04-0.74 and HR: 0.38, 95% CI: 0.22-0.65, respectively). Conclusion. In patients with severe LVD undergoing major vascular surgery, the use of β-blockers is associated with a reduced incidence of in-hospital and long-term postoperative mortality.

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