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European Heart Journal 2001 22(15):1353-1358; doi:10.1053/euhj.2000.2555
Copyright © 2001 by the European Society of Cardiology.
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Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery

D Poldermansa,f1, E Boersmaa, J.J Baxa, I.R Thomsonb, B Paelinckc, L.L.M van de Vena, M.G Schefferd, G Trocinoe, C Vignaf, H.F Baarsg, H van Urka and J.R.T.C Roelandta

a Erasmus Medical Center, Rotterdam, The Netherlands
b The University of Manitoba, Winnipeg, Canada
c University Hospital Antwerp, Antwerp, Belgium
d Sint Clara Ziekenhuis, Rotterdam, The Netherlands
g Twee Steden Ziekenhuis, Tilburg, The Netherlands
e San Gerardo Hospital, Monza, Italy
f Instituto di Ricovero e Cura a Carattere Scientifico Hospital, San Giovanni Rotondo, Italy

revised November 28, 2000; accepted November 29, 2000

Abstract

Aim To assess the long-term cardioprotective effect of bisoprolol in a randomized high-risk population after successful major vascular surgery. High-risk patients were defined by the presence of one or more cardiac risk factor(s) and a dobutamine echocardiography test positive for ischaemia.

Methods 1351 patients were screened prior to surgery, 846 patients had one or more risk factor(s), and 173 of these patients also had ischaemia during dobutamine echocardiography. One hundred and twelve patients could be randomized for additional bisoprolol therapy or standard care. Eleven patients died in the peri-operative period (up to 1 month after surgery). Randomized patients continued bisoprolol or standard care after surgery. During follow-up of 101 survivors (median 22 months, range 11–30) cardiac death or myocardial infarction was noted. No patient was lost during follow-up.

Results The incidence of cardiac events during follow-up in the bisoprolol group was 12% vs 32% in the standard care group (P=0·025). Cardiac death occurred in 15 patients, nine patients in the standard care and in six in the bisoprolol group; myocardial infarction occurred in six patients, five in the standard care and one in the bisoprolol group. The odds ratio for cardiac death or myocardial infarction after surgery in high-risk patients with additional bisoprolol therapy was 0·30 (0·11–0·83).

Conclusions Bisoprolol significantly reduced long-term cardiac death and myocardial infarction in high-risk patients after successful major cardiac vascular surgery.

Key Words: Major vascular surgery, long-term follow-up, high-risk patients, beta-blockers

f1 Correspondence: Don Poldermans, MD, PhD, Thoraxcentre, Room H921‘, Erasmus University, Rotterdam, The Netherlands.


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