Document Detail

Impact of combination medical therapy on mortality in vascular surgery patients.
MedLine Citation:
PMID:  20394027     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Th use of beta-blockers or statins has been associated with decreased mortality after noncardiac surgery. There are no prior perioperative studies of concurrent use of other cardioprotective drugs. OBJECTIVE: To ascertain whether combinations of aspirin, beta-blockers, statins, and/or angiotensin-converting enzyme (ACE) inhibitors were associated with decreased mortality 6 months after vascular surgery. PATIENTS AND DESIGN: We performed a retrospective cohort study on the 3020 patients who underwent vascular surgery between January 1998 and March 2005 at 5 regional Veterans Affairs (VA) medical centers. The Cochran-Mantel-Haenszel test was used to assess associations with 6-month all-cause mortality for the combination drug exposures compared to no exposure while adjusting for propensity score. RESULTS: Exposure to all 4 of the study drugs compared to none had a propensity-adjusted relative risk (aRR) of 0.52 (95% confidence interval [CI], 0.26-1.01; P = 0.052), number needed to treat (NNT) 19; 3 drugs vs. none, aRR 0.60 (95% CI, 0.38-0.95; P = 0.030), NNT 38; 2 drugs vs. none, aRR 0.68 (95% CI, 0.46-0.99; P = 0.043), NNT 170; and 1 drug vs. none, aRR 0.88 (95% CI, 0.63-1.22; P = 0.445). ACE inhibitor exposure was common in all combinations. CONCLUSIONS: Combination use of 2 to 3 study drugs, some of which included ACE inhibitors, was associated with decreased mortality after vascular surgery. Combination use of all 4 study drugs was not statistically significant due to the small number of events in this group. Further prospective studies of combination perioperative aspirin, beta-blockers, statins, and ACE inhibitors are warranted.
Thomas W Barrett; Kathleen Newton; Caroline Koudelka; Motomi Mori; Leann Radcliffe
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of hospital medicine : an official publication of the Society of Hospital Medicine     Volume:  5     ISSN:  1553-5606     ISO Abbreviation:  J Hosp Med     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-15     Completed Date:  2010-07-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101271025     Medline TA:  J Hosp Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  218-25     Citation Subset:  IM    
Copyright Information:
(c) 2010 Society of Hospital Medicine.
Section of General Medicine, Portland Veterans Affairs VA Medical Center, Portland, Oregon 97207-1034, USA.
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MeSH Terms
Cohort Studies
Drug Therapy, Combination / methods*
Middle Aged
Outcome Assessment (Health Care)
Postoperative Complications / mortality*,  prevention & control
Retrospective Studies
Risk Adjustment
Vascular Surgical Procedures*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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