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Several small randomized trials have suggested that perioperative β-blockers reduce cardiovascular morbidity among patients undergoing noncardiac surgery. A recent guideline from the American College of Cardiology recommends perioperative β-blockers for certain subgroups (especially high-risk patients who are undergoing high-risk surgery) but acknowledges limitations in the supporting evidence. Two recent double-blind randomized trials complicate the issue.
The multicenter Danish DIPOM trial included 921 diabetic patients (age ≥40) undergoing various types of noncardiac surgery. Patients received metoprolol (given orally when possible, starting before surgery and continuing for 8 days or until discharge) or placebo. There was no significant …