Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1995 Sep;74(3):235–241. doi: 10.1136/hrt.74.3.235

Metoprolol treatment for two years after coronary bypass grafting: effects on exercise capacity and signs of myocardial ischaemia.

H Sjöland 1, K Caidahl 1, L Lurje 1, A Hjalmarson 1, J Herlitz 1
PMCID: PMC484012  PMID: 7547016

Abstract

OBJECTIVE--To evaluate whether prophylactic treatment with metoprolol for two years after coronary artery bypass grafting improves working capacity and reduces the occurrence of myocardial ischaemia in patients with coronary artery disease. METHODS--After coronary artery bypass grafting, patients were randomised to treatment with metoprolol or placebo for two years. Two years after randomisation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise test in 618 patients (64% of all those randomised). RESULTS--The median exercise capacity was 140 W in the metoprolol group (n = 307) and 130 W in the placebo group (n = 311) (P > 0.20). An ST depression of > or = 1 mm at maximum exercise was present in 34% of the patients in the metoprolol group and 38% in the placebo group (P > 0.20) and an ST depression of > or = 2 mm at maximum exercise was present in 11% in the metoprolol group and 16% in the placebo group (P = 0.09). The median values for maximum systolic blood pressure were 200 mm Hg in the metoprolol group and 210 mm Hg in the placebo group (P < 0.0001), while the median values for maximum heart rate were 126 beats/min in the metoprolol group and 143 beats/min in the placebo group (P < 0.0001). The occurrence of cardiac and neurological clinical events two years postoperatively among exercised patients was comparable in the treatment groups. CONCLUSIONS--Treatment with metoprolol for two years after coronary artery bypass grafting did not significantly change exercise capacity or electrocardiographic signs of myocardial ischaemia.

Full text

PDF
236

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ades P. A., Thomas J. D., Hanson J. S., Shapiro S. M., LaMountain J. Effect of metoprolol on the submaximal stress test performed early after acute myocardial infarction. Am J Cardiol. 1987 Nov 1;60(13):963–966. doi: 10.1016/0002-9149(87)90333-x. [DOI] [PubMed] [Google Scholar]
  2. Andersson B., Blomström-Lundqvist C., Hedner T., Waagstein F. Exercise hemodynamics and myocardial metabolism during long-term beta-adrenergic blockade in severe heart failure. J Am Coll Cardiol. 1991 Oct;18(4):1059–1066. doi: 10.1016/0735-1097(91)90767-4. [DOI] [PubMed] [Google Scholar]
  3. Angelhed J. E., Bjurö T. I., Ejdebäck J., Selin K., Schlossman D., Griffith L. S., Bergstrand R., Vedin A., Wilhelmsson C. Computer aided exercise electrocardiographic testing and coronary arteriography in patients with angina pectoris and with myocardial infarction. Br Heart J. 1984 Aug;52(2):140–146. doi: 10.1136/hrt.52.2.140. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Borg G. A. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381. [PubMed] [Google Scholar]
  5. Califf R. M., Harrell F. E., Jr, Lee K. L., Rankin J. S., Hlatky M. A., Mark D. B., Jones R. H., Muhlbaier L. H., Oldham H. N., Jr, Pryor D. B. The evolution of medical and surgical therapy for coronary artery disease. A 15-year perspective. JAMA. 1989 Apr 14;261(14):2077–2086. [PubMed] [Google Scholar]
  6. Campeau L., Enjalbert M., Lespérance J., Bourassa M. G., Kwiterovich P., Jr, Wacholder S., Sniderman A. The relation of risk factors to the development of atherosclerosis in saphenous-vein bypass grafts and the progression of disease in the native circulation. A study 10 years after aortocoronary bypass surgery. N Engl J Med. 1984 Nov 22;311(21):1329–1332. doi: 10.1056/NEJM198411223112101. [DOI] [PubMed] [Google Scholar]
  7. Curtis J. L., Houghton J. L., Patterson J. H., Koch G., Bradley D. A., Adams K. F., Jr Propranolol therapy alters estimation of potential cardiovascular risk derived from submaximal postinfarction exercise testing. Am Heart J. 1991 Jun;121(6 Pt 1):1655–1664. doi: 10.1016/0002-8703(91)90009-7. [DOI] [PubMed] [Google Scholar]
  8. Dubach P., Froelicher V., Klein J., Detrano R. Use of the exercise test to predict prognosis after coronary artery bypass grafting. Am J Cardiol. 1989 Mar 1;63(9):530–533. doi: 10.1016/0002-9149(89)90894-1. [DOI] [PubMed] [Google Scholar]
  9. Engelmeier R. S., O'Connell J. B., Walsh R., Rad N., Scanlon P. J., Gunnar R. M. Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a double-blind, randomized, placebo-controlled trial. Circulation. 1985 Sep;72(3):536–546. doi: 10.1161/01.cir.72.3.536. [DOI] [PubMed] [Google Scholar]
  10. Frick M. H., Harjola P. T., Valle M. Persistent improvement after coronary bypass surgery: ergometric and angiographic correlations at 5 years. Circulation. 1983 Mar;67(3):491–496. doi: 10.1161/01.cir.67.3.491. [DOI] [PubMed] [Google Scholar]
  11. Gohlke H., Gohlke-Bärwolf C., Samek L., Stürzenofecker P., Schmuziger M., Roskamm H. Serial exercise testing up to 6 years after coronary bypass surgery: behavior of exercise parameters in groups with different degrees of revascularization determined by postoperative angiography. Am J Cardiol. 1983 May 1;51(8):1301–1306. doi: 10.1016/0002-9149(83)90302-8. [DOI] [PubMed] [Google Scholar]
  12. Kaplan J. R., Manuck S. B., Adams M. R., Clarkson T. B. The effects of beta-adrenergic blocking agents on atherosclerosis and its complications. Eur Heart J. 1987 Sep;8(9):928–944. doi: 10.1093/oxfordjournals.eurheartj.a062370. [DOI] [PubMed] [Google Scholar]
  13. Lundborg P., Aström H., Bengtsson C., Fellenius E., von Schenck H., Svensson L., Smith U. Effect of beta-adrenoceptor blockade on exercise performance and metabolism. Clin Sci (Lond) 1981 Sep;61(3):299–305. doi: 10.1042/cs0610299. [DOI] [PubMed] [Google Scholar]
  14. Myers W. O., Schaff H. V., Gersh B. J., Fisher L. D., Kosinski A. S., Mock M. B., Holmes D. R., Ryan T. J., Kaiser G. C. Improved survival of surgically treated patients with triple vessel coronary artery disease and severe angina pectoris. A report from the Coronary Artery Surgery Study (CASS) registry. J Thorac Cardiovasc Surg. 1989 Apr;97(4):487–495. [PubMed] [Google Scholar]
  15. Olsson G., Rehnqvist N., Freyschuss U., Zetterquist S. Influence of long-term metoprolol treatment on early and late exercise test performance after acute myocardial infarction. Am J Cardiol. 1988 Mar 1;61(8):519–523. doi: 10.1016/0002-9149(88)90757-6. [DOI] [PubMed] [Google Scholar]
  16. Pahlm O., Sörnmo L. Data processing of exercise ECG's. IEEE Trans Biomed Eng. 1987 Feb;34(2):158–165. doi: 10.1109/tbme.1987.326040. [DOI] [PubMed] [Google Scholar]
  17. Reynolds J. L., Whitlock R. M. Effects of a beta-adrenergic receptor blocker in myocardial infarction treated for one year from onset. Br Heart J. 1972 Mar;34(3):252–259. doi: 10.1136/hrt.34.3.252. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Rønnevik P. K., Gundersen T., Abrahamsen A. M., Knutsen H., Woie L. Effect of metoprolol on early exercise-induced ST-segment changes and ventricular arrhythmias in patients with suspected acute myocardial infarction. Int J Cardiol. 1989 Jan;22(1):51–57. doi: 10.1016/0167-5273(89)90135-6. [DOI] [PubMed] [Google Scholar]
  19. Rønnevik P. K., Gundersen T., Abrahamsen A. M. Long-term effect of beta-blockade with timolol on maximal work capacity following myocardial infarction. Eur Heart J. 1983 Nov;4(11):773–780. doi: 10.1093/oxfordjournals.eurheartj.a061397. [DOI] [PubMed] [Google Scholar]
  20. Smith S. H., Geer J. C. Morphology of saphenous vein-coronary artery bypass grafts: Seven to 116 months after surgery. Arch Pathol Lab Med. 1983 Jan;107(1):13–18. [PubMed] [Google Scholar]
  21. Thadani U., Davidson C., Singleton W., Taylor S. H. Comparison of five beta-adrenoreceptor antagonists with different ancillary properties during sustained twice daily therapy in angina pectoris. Am J Med. 1980 Feb;68(2):243–250. doi: 10.1016/0002-9343(80)90361-7. [DOI] [PubMed] [Google Scholar]
  22. Visser F. C., van Campen L., de Feyter P. J. Value and limitations of exercise stress testing to predict the functional results of coronary artery bypass grafting. Int J Card Imaging. 1993;9 (Suppl 1):41–47. doi: 10.1007/BF01143145. [DOI] [PubMed] [Google Scholar]
  23. Waagstein F., Bristow M. R., Swedberg K., Camerini F., Fowler M. B., Silver M. A., Gilbert E. M., Johnson M. R., Goss F. G., Hjalmarson A. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Lancet. 1993 Dec 11;342(8885):1441–1446. doi: 10.1016/0140-6736(93)92930-r. [DOI] [PubMed] [Google Scholar]
  24. Wagner N. B., Sevilla D. C., Krucoff M. W., Lee K. L., Pieper K. S., Kent K. K., Bottner R. K., Selvester R. H., Wagner G. S. Transient alterations of the QRS complex and ST segment during percutaneous transluminal balloon angioplasty of the left anterior descending coronary artery. Am J Cardiol. 1988 Nov 15;62(16):1038–1042. doi: 10.1016/0002-9149(88)90544-9. [DOI] [PubMed] [Google Scholar]
  25. Weiner D. A., Ryan T. J., Parsons L., Fisher L. D., Chaitman B. R., Sheffield L. T., Tristani F. E. Prevalence and prognostic significance of silent and symptomatic ischemia after coronary bypass surgery: a report from the Coronary Artery Surgery Study (CASS) randomized population. J Am Coll Cardiol. 1991 Aug;18(2):343–348. doi: 10.1016/0735-1097(91)90584-v. [DOI] [PubMed] [Google Scholar]
  26. Yli-Mäyry S., Huikuri H. V., Korhonen U. R., Airaksinen K. E., Ikäheimo M. J., Linnaluoto M. K., Takkunen J. T. Prevalence and prognostic significance of exercise-induced ventricular arrhythmias after coronary artery bypass grafting. Am J Cardiol. 1990 Dec 15;66(20):1451–1454. doi: 10.1016/0002-9149(90)90532-6. [DOI] [PubMed] [Google Scholar]
  27. van Baak M. A., Böhm R. O., Arends B. G., van Hooff M. E., Rahn K. H. Long-term antihypertensive therapy with beta-blockers: submaximal exercise capacity and metabolic effects during exercise. Int J Sports Med. 1987 Oct;8(5):342–347. doi: 10.1055/s-2008-1025681. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES