Prevention of acute coronary events in noncardiac surgery: beta-blocker therapy and coronary revascularization.
During major vascular surgery, patients are at high risk for developing myocardial infarction and myocardial ischemia, and two risk-reduction strategies can be considered prior to surgery: pharmacological treatment and prophylactic coronary revascularization. beta-blockers are established therapeutic agents for patients with hypertension, heart failure and coronary artery disease. There is still considerable debate concerning the protective effect of beta-blocker therapy towards perioperative coronary events, which will be outlined in this article. Two randomized, controlled trials suggest that coronary revascularization of cardiac-stable patients provides no benefits in the postoperative outcomes. In the current American College of Cardiology/American Heart Association guidelines for 'Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery', routine prophylactic coronary revascularization is not recommended in patients with stable coronary artery disease. However, a recent retrospective, observational study suggests that intermediate-risk patients may benefit from preoperative coronary revascularization. The present article provides an extended overview of leading observational studies, randomized, controlled trials, meta-analyses and guidelines assessing perioperative beta-blocker therapy and prophylactic coronary revascularization.
Department of Vascular Surgery, Erasmus Medical Center, Room H921, 's-Gravendijkwal 230, 3015 GE, Rotterdam, The Netherlands.
Willem-Jan
WJ
Flu
Jan-Peter
JP
van Kuijk
Tamara
T
Winkel
Sanne
S
Hoeks
Jeroen
J
Bax
Don
D
Poldermans
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D006801:Humans; D015201:Meta-Analysis as Topic; D017202:Myocardial Ischemia / Q000209:etiology* / Q000517:prevention & control*; D009204:Myocardial Revascularization; D019990:Perioperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
D000319:Adrenergic beta-Antagonists