Another Look at Perioperative Beta-Blockers in Noncardiac Surgery

In a meta-analysis, a beneficial therapy is challenged by debatable evidence.

The 2007 updated ACC/AHA guidelines for perioperative cardiovascular management of patients undergoing noncardiac surgery (JW Cardiol Nov 28 2007) recommend the use of beta-blockers to reduce the incidence of MI in patients at intermediate or high risk, although many of the randomized, controlled trials supporting the recommendation were small and produced mixed results. In the largest trial to date, involving 8351 patients and published in 2008 (JW Cardiol May 14 2008), perioperative metoprolol succinate at a high preoperative dose was associated with a 30% reduction in nonfatal MI, but also was associated with a 33% increase in all-cause mortality, mainly driven by a doubling of stroke risk.

Now, researchers have conducted a meta-analysis …

Reviewing Author

Beat J. Meyer, MD

Disclosures

Leadership positions in professional societiesBern Heart Foundation (President); International Academy of Medicine, Bern, Switzerland (Director)

Beat J. Meyer, MD

Disclosures

Leadership positions in professional societiesBern Heart Foundation (President); International Academy of Medicine, Bern, Switzerland (Director)