Anesthesiology, University of California, San Francisco, San Francisco, California, USA.
Anesthesiology. 2011 Apr;114(4):824-36. doi: 10.1097/ALN.0b013e3182110e83.
The Atenolol study of 1996 provided evidence that perioperative β-blockade reduced postsurgical mortality. In 1998, the indications for perioperative β-blockade were codified as the Perioperative Cardiac Risk Reduction protocol and implemented at the San Francisco Veterans Affairs Medical Center. The current study tested the following hypothesis: Is there a difference in mortality rates between patients receiving perioperative atenolol and metoprolol?
Epidemiologic analysis of the operations performed at the San Francisco Veterans Affairs Medical Center since 1996 was performed. High-risk inpatients with perioperative β-blockade were divided into two groups: patients who received perioperative atenolol only and those who received metoprolol only. Patients who switched between the two chronic oral β-blocker medications were excluded. IV administration of β-blockers was ignored. Propensity matching analysis was used to correct for population differences in risk factors.
There were 38,779 operations performed from 1996 to 2008, with 24,739 inpatient procedures. Based on analysis of inpatient medication use, 3,787 patients received atenolol only (1,011) or metoprolol only (2,776). Thirty-day mortality (atenolol 1% vs. metoprolol 3%, P < 0.0008) and 1-yr mortality (atenolol 7% vs. metoprolol 13%, P < 0.0001) differed between the two β-blockers. Analysis based on inpatient and outpatient β-blocker use showed a similar pattern. Propensity matching that corrected for multiple cardiac risk factors found an odds ratio (OR) of 2.1 [95% CI 1.5-2.9], P < 0.0001 for increased 1-yr mortality with metoprolol for inpatient use.
Perioperative β-blockade using atenolol is associated with reduced mortality compared with metoprolol.
1996 年的阿替洛尔研究提供了证据，表明围手术期β受体阻滞剂可降低术后死亡率。1998 年，围手术期β受体阻滞剂的适应证被编纂为围手术期心脏风险降低方案，并在旧金山退伍军人事务医疗中心实施。本研究检验了以下假设：接受围手术期阿替洛尔和美托洛尔治疗的患者之间死亡率是否存在差异？
对 1996 年以来旧金山退伍军人事务医疗中心进行的手术进行了流行病学分析。将接受围手术期β受体阻滞剂的高危住院患者分为两组：仅接受围手术期阿替洛尔的患者和仅接受美托洛尔的患者。排除了在两种慢性口服β受体阻滞剂之间转换的患者。忽略了β受体阻滞剂的静脉给药。采用倾向匹配分析校正人群中危险因素的差异。
1996 年至 2008 年共进行了 38779 例手术，其中 24739 例为住院手术。根据住院用药分析，3787 例患者仅接受阿替洛尔（1011 例）或美托洛尔（2776 例）治疗。30 天死亡率（阿替洛尔 1%比美托洛尔 3%，P<0.0008）和 1 年死亡率（阿替洛尔 7%比美托洛尔 13%，P<0.0001）在两种β受体阻滞剂之间存在差异。基于住院和门诊β受体阻滞剂使用情况的分析显示出类似的模式。对多个心脏危险因素进行校正的倾向匹配发现，住院使用美托洛尔与 1 年死亡率增加相关的比值比（OR）为 2.1（95%CI 1.5-2.9），P<0.0001。
与美托洛尔相比，围手术期使用阿替洛尔的β受体阻滞剂与降低死亡率相关。
