阿替洛尔对非心脏手术后死亡率和心血管疾病发病率的影响。围手术期缺血研究组多中心研究。

Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group.

作者信息

Mangano D T, Layug E L, Wallace A, Tateo I

机构信息

San Francisco Veterans Affairs Medical Center and University of California, CA 94121, USA.

出版信息

N Engl J Med. 1996 Dec 5;335(23):1713-20. doi: 10.1056/NEJM199612053352301.

DOI:10.1056/NEJM199612053352301

PMID:8929262

Abstract

BACKGROUND

Perioperative myocardial ischemia is the single most important potentially reversible risk factor for mortality and cardiovascular complications after noncardiac surgery. Although more than 1 million patients have such complications annually, there is no effective preventive therapy.

METHODS

We performed a randomized, double-blind, placebo-controlled trial to compare the effect of atenolol with that of a placebo on overall survival and cardiovascular morbidity in patients with or at risk for coronary artery disease 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 two years.

RESULTS

A total of 200 patients were enrolled. Ninety-nine 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 two 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 six months following hospital discharge (0 vs. 8 percent, P<0.001), over the first year (3 percent 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 from cardiac causes during the first six to eight months. Combined cardiovascular 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 coronary artery disease who must undergo noncardiac surgery, treatment with atenolol during hospitalization can reduce mortality and the incidence of cardiovascular complications for as long as two years after surgery.

摘要

背景

围手术期心肌缺血是心脏手术以外的手术术后死亡和心血管并发症最重要的潜在可逆危险因素。尽管每年有超过100万患者出现此类并发症，但尚无有效的预防治疗方法。

方法

我们进行了一项随机、双盲、安慰剂对照试验，比较阿替洛尔与安慰剂对接受非心脏手术的冠心病患者或有冠心病风险患者的总生存率和心血管发病率的影响。阿替洛尔在手术前和手术后立即静脉给药，之后在住院期间口服给药。对患者进行了为期两年的随访。

结果

共纳入200例患者。99例被分配到阿替洛尔组，101例被分配到安慰剂组。194例患者存活至出院，其中192例接受了两年的随访。在出院后的六个月内（0%对8%，P<0.001）、第一年（3%对14%，P=0.005）和两年内（10%对21%，P=0.019），阿替洛尔治疗组患者出院后的总体死亡率显著低于接受安慰剂治疗的患者。主要影响是在最初的六到八个月内，心脏原因导致的死亡减少。阿替洛尔治疗组患者的综合心血管结局也有类似程度的降低；在整个两年研究期间，安慰剂组的无事件生存率为68%，阿替洛尔组为83%（P=0.008）。