CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 2, March/April 2010
102
AFRICA
blocker therapy.
19
As heart rate tends to increase in the first three postoperative
days,
20
it is likely therefore that a heart rate change of as little as
six beats per minute may be associated with significant myocar-
dial ischaemia in vascular surgical patients who were chronically
beta-blocked and then withdrawn from therapy.
Conclusion
An increase in the mean daily heart rate of
≥
six beats per minute
is independently associated with in-hospital mortality following
the withdrawal of chronic beta-blockade in vascular surgical
patients. It is possible that re-institution of beta-blockade or other
techniques of rate control in these patients may improve survival.
The relationship between the postoperative heart rate and both
the dose of chronic beta-blockade and circadian rhythm needs
further investigation.
References
Giles JW, Sear JW, Foex P. Effect of chronic beta-blockade on peri-
1.
operative outcome in patients undergoing non-cardiac surgery: an
analysis of observational and case control studies.
Anaesthesia
2004;
59
(6): 574–583.
Shammash JB, Trost JC, Gold JM, Berlin JA, Golden MA, Kimmel SE.
2.
Perioperative beta-blocker withdrawal and mortality in vascular surgical
patients.
Am Heart J
2001;
141
(1): 148–153.
Hoeks SE, Scholte Op Reimer WJ, van Urk H, Jorning PJ, Boersma E,
3.
Simoons ML,
et al
. Increase of 1-year mortality after perioperative beta-
blocker withdrawal in endovascular and vascular surgery patients.
Eur J
Vasc Endovasc Surg
2007;
33
(1): 13–19.
Biccard BM, Pooran RR. Validation of a model to predict all-cause
4.
in-hospital mortality in vascular surgical patients.
Cardiovasc J Afr
2008;
19
(6): 303–308.
Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA,
5.
Cook EF,
et al
. Derivation and prospective validation of a simple index
for prediction of cardiac risk of major noncardiac surgery.
Circulation
1999;
100
(10): 1043–1049.
Goldhill DR, McNarry AF. Physiological abnormalities in early warning
6.
scores are related to mortality in adult inpatients.
Br J Anaesth
2004;
92
(6): 882–884.
Leung JM, Dzankic S. Relative importance of preoperative health
7.
status versus intraoperative factors in predicting postoperative adverse
outcomes in geriatric surgical patients.
J Am Geriatr Soc
2001;
49
(8):
1080–1085.
Biccard BM, Bandu R. Clinical risk predictors associated with cardi-
8.
ac mortality following vascular surgery in South African patients.
Cardiovasc J Afr
2007;
18
(4): 216–220.
Ridley S. Cardiac scoring systems – what is their value?
9.
Anaesthesia
2003;
58
(10): 985–991.
Coetzee JF. Evaluating diagnostic tests.
10.
S Afr J Anaesthes Analges
2004(November): 7–15.
Kertai MD, Boersma E, Bax JJ, Heijenbrok-Kal MH, Hunink MG,
11.
L’Talien G J,
et al
. A meta-analysis comparing the prognostic accuracy
of six diagnostic tests for predicting perioperative cardiac risk in patients
undergoing major vascular surgery.
Heart
2003;
89
(11): 1327–1334.
Rinfret S, Goldman L, Polanczyk CA, Cook EF, Lee TH. Value of imme-
12.
diate postoperative electrocardiogram to update risk stratification after
major noncardiac surgery.
Am J Cardiol
2004;
94
(8): 1017–1022.
Burger AJ, Kamalesh M. Effect of beta-adrenergic blocker therapy on
13.
the circadian rhythm of heart rate variability in patients with chronic
stable angina pectoris.
Am J Cardiol
1999;
83
(4): 596–598, A8.
Figueras J, Lidon RM. Early morning reduction in ischemic threshold
14.
in patients with unstable angina and significant coronary disease.
Circulation
1995;
92
(7): 1737–1742.
Li JJ. Circadian variation in myocardial ischemia: the possible mech-
15.
anisms involving in this phenomenon.
Med Hypoth
2003;
61
(2):
240–243.
Tzivoni D, Medina A, David D, BarzilaiY, Brunel P. Effect of metoprolol
16.
in reducing myocardial ischemic threshold during exercise and during
daily activity.
Am J Cardiol
1998;
81
(6): 775–777.
Gardner MJ, Altman DG.
17.
Statistics with Confidence
–
Confidence
Intervals and Statistical Guidelines
. London: British Medical Journal,
1989.
Stone PH, Gibson RS, Glasser SP, DeWood MA, Parker JD, Kawanishi
18.
DT,
et al
. Comparison of propranolol, diltiazem, and nifedipine in
the treatment of ambulatory ischemia in patients with stable angina.
Differential effects on ambulatory ischemia, exercise performance, and
anginal symptoms. The ASIS Study Group.
Circulation
1990;
82
(6):
1962–1972.
McLenachan JM, Weidinger FF, Barry J, Yeung A, Nabel EG, Rocco
19.
MB,
et al
. Relations between heart rate, ischemia, and drug therapy
during daily life in patients with coronary artery disease.
Circulation
1991;
83
(4): 1263–1270.
Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL,
20.
Blankensteijn JD,
et al
. The effect of bisoprolol on perioperative mortal-
ity and myocardial infarction in high-risk patients undergoing vascular
surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying
Stress Echocardiography Study Group.
N Engl J Med
1999;
341
(24):
1789–1794.
SCM 2010: 2nd Lugano Stem Cell Meeting: 22–23 June 2010
Cardiocentro Ticino, Lugano, Switzerland
MTE 2010 (Meet the Experts): 6th Interventional Symposium on High-Risk
Coronary Interventions: 23–25 June 2010
Cardiocentro Ticino, Lugano, Switzerland
To register or for more information email
Save these dates
