28. Support: Poldermans III

Poldermans et. al. 1999 suggests an even more simplified approach. Three facts must be remembered.

Patients with high risk for coronary artery disease (age over 70, angina, prior myocardial infarction on the basis of history or a finding of pathologic Q waves on electrocardiogrpahy; compensated congestive heart failure or a history for congestive heart failure, concurrent treatment for ventricular arrhythmias, current treatment for diabetes mellitus, or limited exercise tolerance, defined as the inability to perform most normal daily activities) who also had a positive dobutamine echocardiogram, had a 3% perioperative mortality when treated with perioperative beta blockers and then underwent major vascular surgery (abdominal or infrainguinal aortic reconstruction).
Patients who undergo CABG surgery have a 3.2% overall mortality, 3% stroke rate, 10% nursing home admission rate.
Two of the four patients excluded from Polderman et. al., who had a dobutamine echocardiogram with extensive wall motion abnormalities, who underwent CABG, died. Two out of four patients, is a 50% mortality for patients given CABG prior to vascular surgery for floridly positive dobutamine echocardiograms.
Risk of CABG 3.2%
Risk of Major Vascular Surgery in Highest Risk Group on Beta Blockers: 3.0%
Risk of Major Vascular Surgery in Highest Risk Group not on Beta Blockers: 30%
Risk of Major Vascular Surgery After CABG 1.5%
You do the math: 3.0% is less than 3.2% + 1.5%.

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