Effect of Atenolol on Mortality and Cardiovascular Morbidity after Noncardiac Surgery
Dennis T. Mangano, Ph.D., M.D., Elizabeth L. Layug, M.D., Arthur Wallace, Ph.D., M.D., Ida Tateo, M.S., for The Multicenter Study of Perioperative Ischemia Research Group
Background Perioperative myocardial ischemia is the single mostimportant potentially reversible risk factor for mortality andcardiovascular complications after noncardiac surgery. Althoughmore than 1 million patients have such complications annually,there is no effective preventive therapy.
Methods We performed a randomized, double-blind, placebo-controlledtrial to compare the effect of atenolol with that of a placeboon overall survival and cardiovascular morbidity in patientswith or at risk for coronary artery disease who were undergoingnoncardiac surgery. Atenolol was given intravenously beforeand immediately after surgery and orally thereafter for theduration of hospitalization. Patients were followed over thesubsequent two years.
Results A total of 200 patients were enrolled. Ninety-nine wereassigned to the atenolol group, and 101 to the placebo group.One hundred ninety-four patients survived to be discharged fromthe hospital, and 192 of these were followed for two years.Overall mortality after discharge from the hospital was significantlylower among the atenolol-treated patients than among those whowere given placebo over the six months following hospital discharge(0 vs. 8 percent, P<0.001), over the first year (3 percentvs. 14 percent, P = 0.005), and over two years (10 percent vs.21 percent, P = 0.019). The principal effect was a reductionin deaths from cardiac causes during the first six to eightmonths. Combined cardiovascular outcomes were similarly reducedamong the atenolol-treated patients; event-free survival throughoutthe two-year study period was 68 percent in the placebo groupand 83 percent in the atenolol group (P = 0.008).
Conclusions In patients who have or are at risk for coronaryartery disease who must undergo noncardiac surgery, treatmentwith atenolol during hospitalization can reduce mortality andthe incidence of cardiovascular complications for as long astwo years after surgery.
Source Information
From the San Francisco Veterans Affairs Medical Center and University of California, San Francisco (D.T.M., A.W.), and the Ischemia Research and Education Foundation, San Francisco (E.L.L., I.T.).
Address reprint requests to Dr. Mangano at the San Francisco Veterans Affairs Medical Center, 4150 Clement St., 129, San Francisco, CA 94121.
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