Reducing risk of cardiovascular events in noncardiac surgery.
Cardiac adverse events are a major cause of complications in noncardiac surgery. The benefit of preventive coronary artery revascularisation in stable patients before noncardiac surgery has recently been clarified: in the short-term there is no reduction in the number of postoperative myocardial infarction, deaths or hospital length of stay. Coronary artery revascularisation should be limited to these patients who have a well-defined need for the procedure, independent of the need of noncardiac surgery. Optimising medical therapy remains the best option for reducing perioperative complications in stable patients: the addition of statin therapy in candidates for noncardiac surgery with known or strongly suspected coronary disease may be conceived. There is compelling evidence for the use of beta-blockers in reducing cardiac risk. This review presents the studies that support the beneficial effect of beta-blockers, pharmacological effects and some practical aspects in noncardiac surgery. In the management of most of these patients, the use of beta-blockers can aid in the avoidance of a preoperative stress test. The remaining problem to solve is the cost-effective identification of the small group of patients in which the protective effect of beta-blocker therapy is insufficient and a cardiac revascularisation should be considered.
Passamonti
Enrico
E
Division of Cardiology, Istituti Ospitalieri di Cremona, Vl Concordia 1, 26100 Cremona, Italy. epassamonti@tin.it
Pirelli
Salvatore
S
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000191:economics; D003362:Cost-Benefit Analysis; D004608:Eligibility Determination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control*; D019990:Perioperative Care / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors