Randomized Controlled Trial Multicenter Study Clinical Trial
- D Poldermans, E Boersma, J J Bax, I R Thomson, B Paelinck, L L van de Ven, M G Scheffer, G Trocino, C Vigna, H F Baars, H van Urk, J R Roelandt, and Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group.
- Erasmus Medical Center, Rotterdam, The Netherlands.
- Eur. Heart J.. 2001 Aug 1;22(15):1353-8.
AimTo 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.Methods1351 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).ConclusionsBisoprolol significantly reduced long-term cardiac death and myocardial infarction in high-risk patients after successful major cardiac vascular surgery.Copyright 2001 The European Society of Cardiology.
This article appears in the collection: Peri-operative beta blockade.
One of the early papers that lit the fire under the pro-periop beta-blocker camp. Note that the legitimacy of Poldermans' DECREASE trials has been called into question due to scientific misconduct (read more)
Results from more recent trials, such as POISE greatly undermine Poldermans' rather extraordinary findings in this paper.
"Extraordinary claims require extraordinary evidence" — Carl Sagan
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