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ACC/AHA
Guideline Update for Perioperative Cardiovascular Evaluation
for Noncardiac Surgery
A
Report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines
(Committee to Update the 1996 Guidelines on Perioperative
Cardiovascular Evaluation for Noncardiac Surgery)
(Printer-friendly
version)
Revised
Table 10. Perioperative
Prophylactic Anti-Ischemic Medications and Cardiac Morbidity
|
Ischemia*
|
MI
|
Death
|
|
Author
|
Procedure
|
n
|
Control
|
Drug
|
Control
|
Drug
|
Control
|
Drug
|
Control
|
Drug
|
|
Nitroglycerin
|
|
Coriat
1984 (183)
|
Carotid
endarterectomy
|
45
|
0.5
mcg per kg per min
nitroglycerin
|
1
mcg per min
nitroglycerin
intraoperatively
|
14/22
(64%)
|
4/23*
(17%)
|
0/22
(0)
|
0/23
(0)
|
|
|
|
Dodds
1993 (184)
|
Noncardiac
|
45
|
Placebo
|
0.9
mcg per kg per min nitroglycerin
intraoperatively
|
7/22
(32%)
|
7/23
(30%)
|
1/22
(5%)
|
0/23
(0)
|
|
|
|
Calcium
channel blockers
|
|
Godet
1987 (185)
|
Vascular
|
30
|
Placebo
|
3
mcg per kg per min
diltiazem
intraoperatively
|
11/15
(73%)
|
6/15
(40%)
|
0/15
(0)
|
0/15
(0)
|
|
|
|
Beta-adrenergic
blockers
|
|
Pasternack
1987 (186)
|
Abdominal
aortic aneurysmorrhaphy
|
83
|
Case-control
|
50
mg PO metoprolol preoperatively
|
|
|
9/51
(17.6%)
|
1/32†
(3.1%)
|
|
|
|
Pasternack
1989 (58)
|
Vascular
|
200
|
Unblinded
|
50
mg PO metoprolol preoperatively
|
1.8+3.2*
episodes
|
0.8+1.6
episodes
|
|
|
|
|
|
Stone
1988 (55)
|
Noncardiac
Mild
hypertension
|
128
|
Placebo
|
labetalol
atenolol
olprenolol
PO
preoperatively
|
11/39
(28%)
|
2/89*
(2%)
|
0/39
(0)
|
0/89
(0)
|
|
|
|
Poldermans
1999 (252)
|
Vascular
|
112
|
Unblinded
|
5
to 10 mg PO
bisoprolol
|
|
|
9/53
(17%)
|
0/59
(0)
|
9/53
(17%)
|
2/59
(3%)
|
|
Raby
1999 (307)
|
Vascular
|
26
|
Placebo
|
IV
esmolol
|
8/11
(13%)
|
5/15
(33%)
|
|
|
|
|
Wallace
1998 (305)/
|
Noncardiac
|
200
|
Placebo
|
10
to 20 mg IV or 50
|
39/101
|
24/99
|
|
|
(at 6 months)
|
|
Mangano
1996 (251)
|
|
|
|
to
100 mg PO atenolol
|
(39%)
|
(24%)
|
|
|
10/101
(10%)
|
1/99
(1%)
|
|
Alpha-agonists
|
|
McSPI
Group 1997 (309)
|
Noncardiac
|
300
|
Placebo
|
0.75
mcg per kg per h
1.5
mcg per kg per h
mivazerol
|
35/103
(34%)
|
20/98
(20%)
|
6/103
(6%)
|
2/98
(2%)
|
|
|
|
Ellis
1994 (311)
|
Noncardiac
|
61
|
Placebo
|
0.2
to 0.3 mcg
clonidine
|
5/24
(21%)
|
1/28
(4%)
|
|
|
|
|
|
Oliver
1999 (308)
|
Noncardiac
Vascular
|
1897
904
|
Placebo
|
1.5
mcg per kg per h
mivazerol
|
|
|
79/941
(8%)
53/540
(10%)
|
78/946
(8%)
42/454
(9%)
|
25/940
(3%)
18/450
(4%)
|
13/946
(1%)
6/454
(1%)
|
|
Stuhmeier
1996 (310)
|
Vascular
|
297
|
Placebo
|
2
mcg per kg PO
clonidine
|
59/152
(39%)
|
35/145
(24%)
|
4/152
(3%)
|
0/145
(0)
|
1/152
(1%)
|
2/145
(1%)
|
IV
indicates intravenous; MI, myocardial infarction; PO,
by mouth. *Myocardial ischemia. †p less than 0.05 for
drug vs. control.
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