BACKGROUND:Perioperative myocardial ischemia occurs in 20-40% of patients at risk for cardiac complications and is associated with a ninefold increase in risk for perioperative cardiac death, myocardial infarction, or unstable angina, and a twofold long-term risk. Perioperative atenolol administration reduces the risk of death for as long as 2 yr after surgery. This randomized, placebo-controlled, double-blinded trial tested the hypothesis that perioperative atenolol administration reduces the incidence and severity of perioperative myocardial ischemia, potentially explaining the observed reduction in the risk for death. METHODS:Two-hundred patients with, or at risk for, coronary artery disease were randomized to two study groups (atenolol and placebo). Monitoring included a preoperative history and physical examination and daily assessment of any adverse events. Twelve-lead electrocardiography (ECG), three-lead Holter ECG, and creatinine phosphokinase with myocardial banding (CPK with MB) data were collected 24 h before until 7 days after surgery. Atenolol (0, 5, or 10 mg) or placebo was administered intravenously before induction of anesthesia and every 12 h after operation until the patient could take oral medications. Atenolol (0, 50, or 100 mg) was administered orally once a day as specified by blood pressure and heart rate. RESULTS: During the postoperative period, the incidence of myocardial ischemia was significantly reduced in the atenolol group: days 0-2 (atenolol 17 of 99 patients; placebo, 34 of 101 patients; P = 0.008) and days 0-7 (atenolol, 24 of 99 patients; placebo, 39 of 101 patients; P = 0.029). Patients with episodes of myocardial ischemia were more likely to die in the next 2 yr (P = 0.025). CONCLUSIONS: Perioperative administration of atenolol for 1 week to patients at high risk for coronary artery disease significantly reduces the incidence of postoperative myocardial ischemia. Reductions in perioperative myocardial ischemia are associated with reductions in the risk for death at 2 yr.
RCT Entities:
BACKGROUND: Perioperative myocardial ischemia occurs in 20-40% of patients at risk for cardiac complications and is associated with a ninefold increase in risk for perioperative cardiac death, myocardial infarction, or unstable angina, and a twofold long-term risk. Perioperative atenolol administration reduces the risk of death for as long as 2 yr after surgery. This randomized, placebo-controlled, double-blinded trial tested the hypothesis that perioperative atenolol administration reduces the incidence and severity of perioperative myocardial ischemia, potentially explaining the observed reduction in the risk for death. METHODS: Two-hundred patients with, or at risk for, coronary artery disease were randomized to two study groups (atenolol and placebo). Monitoring included a preoperative history and physical examination and daily assessment of any adverse events. Twelve-lead electrocardiography (ECG), three-lead Holter ECG, and creatinine phosphokinase with myocardial banding (CPK with MB) data were collected 24 h before until 7 days after surgery. Atenolol (0, 5, or 10 mg) or placebo was administered intravenously before induction of anesthesia and every 12 h after operation until the patient could take oral medications. Atenolol (0, 50, or 100 mg) was administered orally once a day as specified by blood pressure and heart rate. RESULTS: During the postoperative period, the incidence of myocardial ischemia was significantly reduced in the atenolol group: days 0-2 (atenolol 17 of 99 patients; placebo, 34 of 101 patients; P = 0.008) and days 0-7 (atenolol, 24 of 99 patients; placebo, 39 of 101 patients; P = 0.029). Patients with episodes of myocardial ischemia were more likely to die in the next 2 yr (P = 0.025). CONCLUSIONS: Perioperative administration of atenolol for 1 week to patients at high risk for coronary artery disease significantly reduces the incidence of postoperative myocardial ischemia. Reductions in perioperative myocardial ischemia are associated with reductions in the risk for death at 2 yr.
Authors: P J Devereaux; W Scott Beattie; Peter T-L Choi; Neal H Badner; Gordon H Guyatt; Juan C Villar; Claudio S Cinà; Kate Leslie; Michael J Jacka; Victor M Montori; Mohit Bhandari; Alvaro Avezum; Alexandre B Cavalcanti; Julian W Giles; Thomas Schricker; Homer Yang; Carl-Johan Jakobsen; Salim Yusuf Journal: BMJ Date: 2005-07-04
Authors: Anne Benedicte Juul; Jørn Wetterslev; Christian Gluud; Allan Kofoed-Enevoldsen; Gorm Jensen; Torben Callesen; Peter Nørgaard; Kim Fruergaard; Morten Bestle; Rune Vedelsdal; André Miran; Jon Jacobsen; Jakob Roed; Maj-Britt Mortensen; Lise Jørgensen; Jørgen Jørgensen; Marie-Louise Rovsing; Pernille Lykke Petersen; Frank Pott; Merete Haas; Rikke Albret; Lise Lotte Nielsen; Gun Johansson; Pia Stjernholm; Yvonne Mølgaard; Nikolai Bang Foss; Jeanie Elkjaer; Bjørn Dehlie; Klavs Boysen; Dusanka Zaric; Anne Munksgaard; Jørn Bo Madsen; Bjarne Øberg; Boris Khanykin; Tine Blemmer; Stig Yndgaard; Grazyna Perko; Lars Peter Wang; Per Winkel; Jørgen Hilden; Per Jensen; Nader Salas Journal: BMJ Date: 2006-06-24