Impact of Prophylactic β-Blocker Therapy to Prevent Stroke After Noncardiac Surgery

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• 作者：Felix van Lier ; Olaf Schouten ; Sanne E. Hoeks ; Louis van de Ven ; Robert Jan Stolker ; Jeroen J. Bax ; Don Poldermans
• 刊名：The American Journal of Cardiology
• 出版年：2010
• 出版时间：1 January 2010
• 年：2010
• 卷：105
• 期：1
• 页码：43-47
• 全文大小：151 K

文摘

β Blockers are widely used to improve the postoperative cardiac outcome in patients with coronary artery disease scheduled for noncardiac surgery. However, recently serious concerns regarding the safety of perioperative β blockers have emerged. To assess the incidence, risk factors, and β-blocker use associated with postoperative stroke in the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) trials, we evaluated all 3,884 patients of the DECREASE trials for postoperative stroke. All cardiac risk factors and medication use were assessed. The incidence of stroke within 30 days after surgery was recorded. The incidence of postoperative stroke in the DECREASE trials was 0.46 % (18 of 3,884). For the β-blocker users, the incidence was 0.5 % . All the strokes had an ischemic origin. A history of stroke was associated with a greater incidence of postoperative stroke (odds ratio [OR] 3.79, 95 % confidence interval [CI] 1.2 to 11.6). Statins and anticoagulants were not associated with postoperative stroke (OR 0.85, 95 % CI 0.3 to 2.4; and OR 1.27, 95 % CI 0.4 to 4.6, respectively). No association with bisoprolol therapy was found (OR 1.16, 95 % CI 0.4 to 3.4). In conclusion, with a low-dose bisoprolol regimen started ≥30 days before surgery, no association was observed between β-blocker use and postoperative stroke.