β-Blockers Improve In-hospital and Long-term Survival in Patients with Severe Left Ventricular Dysfunction Undergoing Major Vascular Surgery

ObjectivesTo study whether β-blockers reduce in-hospital and long-term mortality in patients with severe left ventricular dysfunction (LVD) undergoing major vascular surgery.DesignObservational cohort study.MaterialsFive hundred and eleven patients with severe LVD (ejection fraction<30%) undergoing major non-cardiac vascular surgery.MethodsIn 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.ResultsMean 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).ConclusionIn 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.