Influence of beta-blockers on the outcome of at risk patients.
Present recommendations for perioperative ss-blockade are solely based on the findings of two randomized controlled trials of inadequate methodology and data analysis in just a little over 300 patients performed in the late 1990s. The PeriOperative ISchemic Evaluation study is the first adequately powered controlled randomized trial on the efficacy and safety of perioperative ss-blocker therapy. During the first 30 postoperative days, the primary endpoint (combined cardiovascular death, non-fatal myocardial infarction and cardiac arrest) was significantly less in the ss-blocker compared to the placebo group, primarily due to a marked reduction in the incidence of non-fatal myocardial infarctions. However, in the ss-blocker group total mortality and the incidence of stroke were higher, negating the beneficial effect of perioperative ss-blocker therapy on the primary endpoint. A recently published meta-analysis confirmed in large parts these findings. Based on these publications, most of the present recommendations for perioperative ss-blocker therapy are no longer supported by evidence and respective revision is needed.
Department of Anaesthesia, University Hospital Freiburg, Freiburg, Germany. priebe@ana1.ukl.uni-freiburg.de
H-Joachim
HJ
Priebe
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D000075202:Contraindications; D003327:Coronary Disease / Q000188:drug therapy; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D015994:Incidence; D015201:Meta-Analysis as Topic; D008790:Metoprolol / Q000627:therapeutic use; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D010101:Oxygen Consumption / Q000187:drug effects; D011183:Postoperative Complications / Q000401:mortality; D017410:Practice Guidelines as Topic; D011229:Preanesthetic Medication / Q000009:adverse effects; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012306:Risk; D013312:Stress, Physiological / Q000187:drug effects; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D008790:Metoprolol