Myocardial protection with prophylactic oral metoprolol during coronary artery bypass grafting surgery: evaluation by troponin I

Abstract

IntroductionBiochemical markers of myocardial injury are frequently altered after cardiac surgery. So far there is no evidence whether oral beta-blockers may reduce myocardial injury after coronary artery bypass grafting. ObjectiveTo determine if oral administration of prophylactic metoprolol reduces the release of cardiac troponin I in isolated coronary artery bypass grafting, not complicated by new Q waves. MethodsA prospective randomized study, including 68 patients, divided in 2 groups: Group A (n=33, control) and B (n=35, beta-blockers). In group B, metoprolol tartrate was administered 200 mg/day. The myocardial injury was assessed by troponin I with 1 hour and 12 hours after coronary artery bypass grafting. ResultsNo significant difference between groups regarding pre-surgical, surgical, complication in intensive care (15% versus 14%, P=0.92) and the total number of hospital events (21% versus 14%, P=0.45) was observed. The median value of troponin I with 12 hours in the study population was 3.3 ng/ml and was lower in group B than in group A (2.5 ng/ml versus 3.7 ng/ml, P<0,05). In the multivariate analysis, the variables that have shown to be independent predictors of troponin I release after 12 hours were: no beta-blockers administration and number of vessels treated. ConclusionThe results of this study in uncomplicated coronary artery bypass grafting, comparing the postoperative release of troponin I at 12 hours between the control group and who used oral prophylactic metoprolol for at least 72 hours, allow to conclude that there was less myocardial injury in the betablocker group, giving some degree of myocardial protection.

Meta-analysis of the benefit of beta-blockers for the reduction of isolated atrial fibrillation incidence after cardiac surgery

“…The final 21 papers were reviewed in full text, and the following were excluded due to the following reasons: 1 study did not have a control group, 6 1 study used sotalol as its study drug, 7 1 study did not segregate outcomes between isolated AF and other forms of SVT, 8 and 1 study focused on the combination therapy of b-blocker and magnesium. 9 Eventually, 17 RCTs, 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 fully satisfying our predefined inclusion criteria, were selected from papers published in varying years. Figure 1 is the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols flow chart of our study as per established 2009 guidelines.…”

“…All trials focused on isolated POAF for patients undergoing cardiac surgery. Eleven trials only included patients who underwent coronary artery bypass grafting (CABG) surgery, 10 , 11 , 12 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 whereas 6 other trials included patients with a variety of surgeries (CABG and valve). 5 , 13 , 15 , 23 , 24 , 25 Study characteristics are summarized in Table 1 .…”

CABG and Preoperative use of Beta-Blockers in Patients with Stable Angina are Associated with Better Cardiovascular Survival

“…Rossi Neto et al. [ 21 ] have shown that the preoperative use of metoprolol is associated with lower levels of troponin I, but no data regarding survival is presented. Our study reflects the outcome of a single center where almost 70% of patients were using beta-blockers previous to CABG.…”

Prognostic prediction of troponins in cardiac myxoma: case study with literature review

“…Yuan et al [ 11 ] discovered significant elevated serum troponin I during the early days after the onset or surgical repair of myocardial rupture, and they advocated the troponin I was valuable in judging the prognosis of the patients with myocardial injury. Troponin I (as well as NT-BNP) can be helpful in the evaluation of the functions of the vital organs including heart subjected to perioperative drug use, such as oral prophylactic metoprolol [ 12 ] and high-dose aprotinin [ 13 ] .…”