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• W2034659259 abstract "S112 INTRODUCTION: Novel therapeutic strategies have attempted to improve cardiovascular outcome in cardiac high-risk patients by modulating the perioperative stress response. Recently, prophylactic atenolol treatment decreased perioperative ECG-detectable myocardial ischemia and cardiovascular complications up to two years after noncardiac surgery [1]. However, the underlying mechanism for this beneficial effect has not been elucidated further. We hypothesized that treatment with atenolol would decrease as-yet unrecognized perioperative myocardial damage as indicated by cardiac troponin I (cTnI) measurements. METHODS: Sixty-three patients with, or at risk for coronary artery disease, scheduled for major elective noncardiac surgery under general anesthesia were randomized to three groups. Group I: no atenolol, Group II: pre- and postoperative atenolol [1], Group III: intraoperative atenolol with a max. end-tidal isoflurane of 0.4 vol.%. Intraoperative mean blood pressure was maintained at +/- 20% of baseline values and heart rate (HR) between 50-80 bpm. Markers for cTnI and CK-MB mass were collected at the following time points: (1) preinduction (2) intubation + 4[prime] (3) incision + 4[prime] (4) incision + 60[prime] (5) 15[prime] after arrival in the post anesthesia care unit (6) 24 hrs and (7) 72 hrs after surgery. cTnI and CK-MB mass were determined using fluorometric assays and Stratus II analyzer (Dade International, Inc. Miami, FL, minimum detectable level for cTnI: <0.4 ng/ml, for CK-MB: 0.4 ng/ml). Two-tailed Fisher's exact test was used for inter-group comparison. RESULTS: All three study groups were comparable with respect to demographic data. None of the patients experienced perioperative cardiovascular complications as indicated by routine clinical investigations. In the beta-blocker groups, rate-pressure product was decreased during surgery and emergence, and HR was decreased up to 72 hours after surgery. Significant increases in perioperative cTnI levels were present in 42% (8/19) of Group I patients (no atenolol), and in 22.5% (9/40) of the beta-blocker-treated patients. Using cTnI levels >1.5 ng/ml to indicate myocardial infarction, 3 patients in group I were retrospectively found to have a clinically unrecognized postoperative myocardial infarction (p=0.03, Figure 1). cTnI levels correlated only weakly with CK-MB mass levels (Spearman's rho =0.35, p=0.001). Increase CK-MB mass levels >4.7 ng/ml were observed in only 7/17 (41%) patients with increased cTnI level >or=to 0.4 ng/ml.Figure 1DISCUSSION: Treatment with atenolol is associated with a lower incidence of tachycardia, reduced rate-pressure product and a lower incidence of elevated cTnI. This is consistent with previous reports in which atenolol decreased perioperative tachycardia, ECG-detectable ischemia and improved cardiovascular outcome up to two years after surgery [2]. In patients with acute coronary syndrome, progressively increasing cTnI levels were associated with an increased risk of mortality, presumably because of the increased amount of myocardial necrosis [3]. We reason that a decrease in as-yet unrecognized perioperative myocardial necrosis (non-Q-wave microinfarction) as indicated by cTnI may be responsible for the improved cardiac outcome in atenolol-treated patients." @default.
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• W2034659259 date "1999-02-01" @default.
• W2034659259 modified "2023-10-18" @default.
• W2034659259 title "ATENOLOL REDUCES PERIOPERATIVE MYOCARDIAL MICROINFARCTION IN CARDIAC HIGH-RISK PATIENTS UNDERGOING NONCARDIAC SURGERY" @default.
• W2034659259 doi "https://doi.org/10.1097/00000539-199902001-00112" @default.
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