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Beta-blockers in non-cardiac surgery

 

Clinical bottom line

The use of ß-blockers in selected patients undergoing noncardiac surgery reduces postoperative cardiac events.


Reference

AD Auerbach, L Goldman. ß-blockers and reduction of cardiac events in noncardiac surgery. JAMA 2002 287: 1435-1444.

Systematic review

A MEDLINE search and reference lists were used to identify randomised studies in which the use of ß-blockers was compared with them not being used in patients undergoing non-cardiac surgery.

Results

Five randomised trials, all small, were found. Most were in high-risk patients. Outcomes included postoperative myocardial infarction, or myocardial ischaemia, or cardiac death over a longer period. Numbers needed to treat for cardiac death, nonfatal myocardial infarction, all cause mortality or myocardial ischaemia ranged from 2.5 to 8.3. Results for myocardial infarction are shown in in Figure 1, and for postoperative ischaemia in Figure 2.

Figure 1: Postoperative MI


Figure 2: Postoperative ischaemia


Comment

This interesting paper has a very useful discussion about which patients should receive perioperative ß-blockers to prevent perioperative cardiac morbidity. While larger and more definitive trials are needed, the size of the effect is sufficiently impressive to consider incorporating the present evidence into practice.