Should this
patient receive perioperative β-adrenergic blockade?
The following describes a randomized,
double-masked, placebo-controlled trial to compare the effect of atenolol with
that of a placebo on overall survival and cardiovascular morbidity in patients
at cardiac risk 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 2
years. Of 200 patients, 99 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 2 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 6
months following hospital discharge (0 vs. 8%, P < 0.001), over the first year (3% vs. 14%, P = 0.005), and over 2 years
(10% vs. 21%, P = 0.019). The principal effect was a reduction in deaths from
cardiac causes during the first 6 to 8 months. Combined cardiovascular outcomes
were similarly reduced among the atenolol-treated patients; event-free survival
throughout the 2-year study period was 68% in the placebo group and 83% in the
atenolol-treated group (P = 0.008). The incidence of diabetes mellitus may have had a
confounding influence on this study, but the results suggest that perioperative
β-adrenergic blockade is potentially quite beneficial in high-risk
patients.
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