Safety and efficacy of patient preparation with intravenous esmolol before 64-slice computed tomography coronary angiography.

OBJECTIVE: To evaluate the safety and efficacy of heart rate reduction by intravenous esmolol in patients who are assigned for coronary angiography with 64-slice computed tomography (CT).

METHODS: Five hundred consecutive patients were prospectively analyzed. Patients with an initial heart rate less than 65 beats per minute (bpm) did not receive esmolol. Patients with a heart rate between 65 and 80 bpm received a bolus dose of 1 mg/kg intravenous esmolol. Patients with an initial heart rate between 80 and 90 bpm received a bolus dose of 2 mg/kg intravenous esmolol. An additional 1 mg/kg intravenous esmolol was given to the patients when the target heart rate was not reached with the first bolus dose. Patients with an initial heart rate more than 90 bpm received 50 mg atenolol PO, and were reevaluated after 1 h.

RESULTS: A total of 391 patients with a heart rate > or =65 bpm before multislice computed tomography (MSCT) examination received intravenous esmolol with a mean dose of 158+/-55 mg. Initial and final mean heart rates were 80+/-11 bpm and 63+/-7 bpm, respectively (P<0.0001). Heart rate below 65 bpm was reached in 265 (65%) of these 391 patients. Only four patients (1%) had a final heart rate above 80 bpm before MSCT imaging. Four of the 391 patients (1%) had a final heart rate below 50 bpm.

CONCLUSION: Intravenous esmolol is safe and effective to reach the optimum heart rate in patients assigned for MSCT.