Ryan J. McColl, MD; Elijah Dixon, MD
In patients having noncardiac surgery, does perioperative use of β-blockers prevent short-term cardiovascular (CV) events?
Included studies compared a β-blocker given in the perioperative period with another drug, placebo, or no intervention in patients, with or without CV disease, having noncardiac surgery. Outcomes were 30-day all-cause mortality, CV mortality, nonfatal myocardial infarction (MI), nonfatal stroke, myocardial ischemia, heart failure, and perioperative adverse events.
PubMed, EMBASE/Excerpta Medica, and Cochrane Library (1966 to May 2008); and references were searched for randomized controlled trials (RCTs). 33 trials (n = 12 306, mean age 33 to 75 y) met the selection criteria. 16 RCTs reported adequate allocation concealment; 29 RCTs were placebo-controlled; and 19 RCTs reported blinding of patients, clinicians, and outcome assessors. 13 trials were considered to be at low risk for bias and 20 at high risk for bias. 1 trial (with low risk for bias) contributed 68% of patients.
β-blocker therapy reduced risk for nonfatal MI and myocardial ischemia and increased risk for stroke (Table). It increased risk for perioperative bradycardia and hypotension but not bronchospasm. The estimate of treatment effect for some outcomes was influenced by trial quality (risk for bias), use of up-titration of β-blockers to achieve a target heart rate, mean heart rate achieved on β-blockers (≤ 75 vs > 75 bpm), and proportion of patients with bradycardia (< 10% vs ≥10%) but not by patient risk status.
In patients having noncardiac surgery, perioperative use of β-blockers provides no clear benefit in preventing short-term cardiovascular events.
β-blockers vs other drugs, placebo, or no treatment (control) in patients having noncardiac surgery*
*MI = myocardial infarction; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, NNH, and CI calculated from data in article using the Peto method.
McColl RJ, Dixon E. Review: Perioperative β-blockers provide no clear benefit in patients having noncardiac surgery. Ann Intern Med. ;150:JC3–4. doi: 10.7326/0003-4819-150-6-200903170-02004
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Published: Ann Intern Med. 2009;150(6):JC3-4.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Heart Failure.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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