β-Adrenergic Blockade and Calcium Channel Blockade in Myocardial Infarction

Frishman, William H.; Skolnick, Alan E.; Lazar, Eliot J.; Fein, Steven

doi:10.1016/s0025-7125(16)30680-0

Cited by 10 publications

(1 citation statement)

References 85 publications

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“…They reduce myocardial oxygen demand as well as increase coronary blood flow Results following the use of calcium channel blockers in acute MI have not been as encouraging as those following the use of (3-blockers or nitroglycerin, although there is evidence that diltiazem may reduce ischemic myocardial injury in acute MI. 79,80,83 Unfortunately, there is limited information concerning the ability of calcium channel blockers to prevent postoperative MI in vascular surgical patients. Godet et al,84 however, did report a small prospective randomized study of vascular surgical patients receiving intravenous diltiazem or placebo.…”

Section: Perioperative P Colooic and Interventional Modalities In Higmentioning

confidence: 99%

Assessing Cardiac Risk in Vascular Surgical Patients: Current Status

Yeager¹,

Moneta²

1989

Perspectives in Vascular Surgery and Endovascular Therapy

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The prevalence of coronary arterial disease in vascular patients is now well appreciated. Several vascular surgical series from the 1960s indicated problems with both perioperative myocardial infarction (MI) and late cardiac death. 1,2 At the Cleveland Clinic from 1969 through 1978 MI accounted for 50% to 60% of operative deaths following aortic surgery 3 In addition, several longitudinal studies of patients with vascular disease have documented a high percentage of late deaths resulting from cardiac causes.4-6 Many vascular surgical series during the 1980s have specifically addressed postoperative MI and cardiac death (Table 1). Presently in the United States at least 50,000 patients annually sustain a perioperative MI, leading to more than 20,000 deaths.35Postoperative MI may be associated with a 50% mortality.36 From 60% to 90% of postoperative MIs occur in the first 3 days after surgery; the remainder generally occur between the fourth and sixth postoperative days.37,3s Approximately 50% of patients with postoperative MIs present without pain but with other clinical indicators for infarction: arrhythmias, hypertension, hypotension, or altered mental status .37 Ischemic ST-T segment changes are sometimes difficult to distinguish from other ECG changes, so creatine kinase isoenzymes are frequently used to confirm postoperative MI.39 Postoperative elevation of the MB isoenzyme > 5 % of the total creatine kinase value is consistent with the occurrence of an acute MI. Charlson et al., 40 however, have emphasized that there is currently no consensus on the definition for postoperative MI, including a lack of uniformity for the method of creatine kinase isoenzyme measurement.Clinically apparent postoperative (within 30 days) MI associated with vascular surgery has an incidence of 2% to 8% (Table 1). Careful prospective evaluation with serial ECGs and analysis of myocardial enzymes, however, increases the overall incidence to 10% to 17% ~8,21,25,31 1 Leppo et al. 31 performed serial examinations for 2 to 3 days and defined MI as typical ECG changes in association with elevation of the creatine kinase MB isoenzyme fraction. They found an incidence of perioperative MI of 17%. Other prospective studies have included some MIs diagnosed only on the basis of elevation of the MB isoenzyme level.18,21,25 Although the incidence of postoperative MI in these studies was relatively high (10% to 16%), the mortality rate of postoperative MI was only 14%. This may either reflect improvement in the management of postoperative MI or more likely demonstrates a lesser significance of clinically inapparent but chemically present MI. In fact, using MB isoenzyme elevation as the sole criterion for diagnosis of at NANYANG TECH UNIV LIBRARY on June 5, 2016 pvs.sagepub.com Downloaded from

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Section: Perioperative P Colooic and Interventional Modalities In Higmentioning

confidence: 99%

Assessing Cardiac Risk in Vascular Surgical Patients: Current Status

Yeager¹,

Moneta²

1989

Perspectives in Vascular Surgery and Endovascular Therapy

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Combination Drug Therapy with Calcium‐Channel Blockers in the Treatment of Systemic Hypertension

Frishman

Landau

Cretkovic

1993

The Journal of Clinical Pharma

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Calcium-channel blockers have been shown to be both safe and effective for treatment of patients with systemic hypertension. These drugs reduce peripheral vascular resistance predominantly by the inhibition of transmembrane calcium ion fluxes in vascular smooth muscle, and by this mechanism can reduce elevated blood pressure. To maximize blood pressure lowering efficacy in patients, calcium-channel blockers have also been used in combination with other antihypertensive treatments that have included diuretics, beta-adrenergic blockers, and angiotensin-converting enzyme inhibitors.

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Drug receptors and control of the cardiovascular system: Recent advances

et al. 1991

Progress in Drug Research / Fortschritte Der Arzneimittelforschung / Progrès Des Recherches Pharmaceutiques

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β-Adrenergic Blockade and Calcium Channel Blockade in Myocardial Infarction

Cited by 10 publications

References 85 publications

Assessing Cardiac Risk in Vascular Surgical Patients: Current Status

Assessing Cardiac Risk in Vascular Surgical Patients: Current Status

Combination Drug Therapy with Calcium‐Channel Blockers in the Treatment of Systemic Hypertension

Drug receptors and control of the cardiovascular system: Recent advances

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