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Volume 335:1713-1721 December 5, 1996 Number 23 Next

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ABSTRACT

Background Perioperative myocardial ischemia is the single most important potentially reversible risk factor for mortality and cardiovascular complications after noncardiac surgery. Although more than 1 million patients have such complications annually, there is no effective preventive therapy.

Methods We performed a randomized, double-blind, placebo-controlled trial to compare the effect of atenolol with that of a placebo on overall survival and cardiovascular morbidity in patients with or at risk for coronary artery disease who were undergoing noncardiac surgery. Atenolol was given intravenously before and immediately after surgery and orally thereafter for the duration of hospitalization. Patients were followed over the subsequent two years.

Results A total of 200 patients were enrolled. Ninety-nine were assigned to the atenolol group, and 101 to the placebo group. One hundred ninety-four patients survived to be discharged from the hospital, and 192 of these were followed for two years. Overall mortality after discharge from the hospital was significantly lower among the atenolol-treated patients than among those who were given placebo over the six months following hospital discharge (0 vs. 8 percent, P<0.001), over the first year (3 percent vs. 14 percent, P = 0.005), and over two years (10 percent vs. 21 percent, P = 0.019). The principal effect was a reduction in deaths from cardiac causes during the first six to eight months. Combined cardiovascular outcomes were similarly reduced among the atenolol-treated patients; event-free survival throughout the two-year study period was 68 percent in the placebo group and 83 percent in the atenolol group (P = 0.008).

Conclusions In patients who have or are at risk for coronary artery disease who must undergo noncardiac surgery, treatment with atenolol during hospitalization can reduce mortality and the incidence of cardiovascular complications for as long as two 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.

Full Text of this Article

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Effect of Atenolol on Mortality and Cardiovascular Morbidity after Noncardiac Surgery
Petros J. A., Ho T., Taussig D., McAnulty G., Devereaux P.J., Ghali W. A., Reis S. E., Feldman A. H., Mangano D. T.
Extract | Full Text  
N Engl J Med 1997; 336:1452-1454, May 15, 1997. Correspondence

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