The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial.
The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial.
复制标题
围手术期 β 受体阻滞剂的影响：血管手术后美托洛尔 (MaVS) 研究的结果，这是一项随机对照试验。
作者：
Homer Yang;K. Raymer;R. Butler;J. Parlow;R. Roberts
背景
接受血管手术的患者是围手术期心脏死亡率和非心脏手术后发病率的最高风险组。许多现行指南建议在所有接受血管手术的患者中使用β受体阻滞剂。我们报告了一项试验的围手术期管理美托洛尔及其对心脏并发症的发生率在血管手术后30天和6个月。
方法
接受腹主动脉手术和腹股沟下或腋股血管重建术的患者被招募到一项双盲随机对照试验中，比较围手术期美托洛尔与安慰剂。患者随机接受研究药物治疗，从术前2小时开始直至出院或术后最多5天。主要结局为术后30天非致死性心肌梗死、不稳定型心绞痛、新发充血性心力衰竭、需要治疗的新发房性或室性心律失常或心源性死亡的复合发生率。
结果
患者随机接受美托洛尔（n = 246）或安慰剂（n = 250）。美托洛尔组和安慰剂组术后30天主要结局事件发生率分别为25例（10.2%）和30例（12.0%）（P = 0.57）（相对风险降低15.3%，95%CI-38.3%至48.2%）。6个月时观察到的效果无显著差异（P = 0.81）（相对风险降低6.2%，95%CI %-58.4%至43.8%）。美托洛尔组需要治疗的术中心动过缓更常见（53/246 vs 19/250，P = .00001），需要治疗的术中低血压也更常见（114/246 vs 84/250，P = .0045）。
结论
我们的结果显示美托洛尔不能有效降低术后30天和6个月的心脏事件发生率。不适用于所有血管患者围手术期预防性使用β受体阻滞剂。
BACKGROUND
Patients undergoing vascular surgery comprise the highest risk group for perioperative cardiac mortality and morbidity after noncardiac procedures. Many current guidelines recommend the use of beta-blockers in all patients undergoing vascular surgery. We report a trial of the perioperative administration of metoprolol and its effects on the incidence of cardiac complications at 30 days and 6 months after vascular surgery.
METHODS
Patients undergoing abdominal aortic surgery and infrainguinal or axillofemoral revascularizations were recruited to a double-blind randomized controlled trial of perioperative metoprolol versus placebo. Patients were randomized to receive study medication, starting 2 hours preoperatively until hospital discharge or maximum of 5 days postoperatively. Primary outcome were postoperative 30-day composite incidence of nonfatal myocardial infarction, unstable angina, new congestive heart failure, new atrial or ventricular dysrhythmia requiring treatment, or cardiac death.
RESULTS
Patients were randomized to receive either metoprolol (n = 246) or placebo (n = 250). Primary outcome events at 30 days postoperative occurred in 25 (10.2%) versus 30 (12.0%) (P = .57) in metoprolol and placebo groups, respectively (relative risk reduction 15.3%, 95% CI -38.3% to 48.2%). Observed effects at 6 months were not significantly different (P = .81) (relative risk reduction 6.2%, 95% CI% -58.4% to 43.8%). Intraoperative bradycardia requiring treatment was more frequent in the metoprolol group (53/246 vs 19/250, P = .00001), as was intraoperative hypotension requiring treatment (114/246 vs 84/250, P = .0045).
CONCLUSION
Our results showed metoprolol was not effective in reducing the 30-day and 6-month postoperative cardiac event rates. Prophylactic use of perioperative beta-blockers in all vascular patients is not indicated.