EFFECT OF ATENOLOL ON MORTALITY AND CARDIOVASCULAR MORBIDITY AFTER NONCARDIAC SURGERY

Background Perioperative myocardial ischemia is the single most import ant potentially reversible risk factor for mortality and cardiovascula r complications after noncardiac surgery. Although more than 1 million patients have such complications annually, there is no effective prev entive therapy. Methods We performed a randomized, double-blind, place bo-controlled trial to compare the effect of atenolol with that of a p lacebo on overall survival and cardiovascular morbidity in patients wi th or at risk for coronary artery disease who were undergoing noncardi ac surgery. Atenolol was given intravenously before and immediately af ter 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 ateno lol group, and 101 to the placebo group. One hundred ninety-four patie nts survived to be discharged from the hospital, and 192 of these were followed for two years. Overall mortality after discharge from the ho spital was significantly lower among the atenolol-treated patients tha n among those who were given placebo over the six months following hos pital discharge (0 vs. 8 percent, P<0.001), over the first year (3 per cent 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 f rom cardiac causes during the first six to eight months. Combined card iovascular 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 coron ary artery disease who must undergo noncardiac surgery, treatment with atenolol during hospitalization can reduce mortality and the incidenc e of cardiovascular complications for as long as two years after surge ry. (C) 1996, Massachusetts Medical Society.