PROPHYLACTIC ATENOLOL REDUCES POSTOPERATIVE MYOCARDIAL-ISCHEMIA

Background Perioperative myocardial ischemia occurs in 20-40% of patie nts at risk for cardiac complications and is associated with a ninefol d increase in risk for perioperative cardiac death, myocardial infarct ion, or unstable angina, and a twofold long-term risk, Perioperative a tenolol administration reduces the risk of death for as long as 2 yr a fter surgery. This randomized, placebo-controlled, double-blinded tria l tested the hypothesis that perioperative atenolol administration red uces the incidence and severity of perioperative myocardial ischemia, potentially explaining the observed reduction in the risk for death. M ethods: Two-hundred patients with, or at risk for, coronary artery dis ease were randomized to two study groups (atenolol and placebo). Monit oring included a preoperative history and physical examination and dai ly assessment of any adverse events. Twelve-lead electrocardiography ( EGG), three-lead Holter EGG, and creatinine phosphokinase with myocard ial 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 oper ation until the patient could take oral medications. Atenolol (0, 50, or 100 mg) was administered orally once a day as specified by blood pr essure and heart rate. Results: During the postoperative period, the i ncidence of myocardial ischemia was significantly reduced in the ateno lol group: days 0-2 (atenolol, 17 of 99 patients; placebo, 34 of 101 p atients; 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).Conclus ions: Perioperative administration of atenolol for 1 week to patients at high risk for coronary artery disease significantly reduces the inc idence of postoperative myocardial ischemia. Reductions in perioperati ve myocardial ischemia are associated with reductions in the risk for death at 2 yr.