Beta-blockers and risk of all-cause mortality in non-cardiac surgery.
Myocardial ischemia is a frequent complication in patients undergoing non-cardiac surgery and beta-blockers may exert a protective effect. The main benefit of beta-blockers in perioperative cardiovascular morbidity and mortality is believed to be linked to specific effects on myocardial oxygen supply and demand. beta-blockers may exert anti-inflammatory and anti-arrhythmic effects. Randomized clinical trials which evaluated the effects of beta-blockers on all-cause mortality in patients undergoing non-cardiac surgery have yielded conflicting results. In 9 trials, 10,544 patients with non-cardiac surgery were randomized to beta-blockers (n = 5274) or placebo (n = 5270) and there were a total of 304 deaths. Patients randomized to beta-blockers group showed a 19% increased risk of all-cause mortality (odds ratio [OR] 1.19, 95% confidence interval (CI) 0.95-1.50; p = 0.135). However, trials included in the meta-analysis differed in several aspects, and a significant degree of heterogeneity (I( 2) = 46.5%) was noted. A recent analysis showed that the surgical risk category had a substantial influence on the overall estimate of the effect of beta-blockers. Compared with patients in the intermediate-high-surgical-risk category, those in the high-risk category showed a 73% reduction in the risk of total mortality with beta-blockers compared with placebo (OR 0.27, 95% CI 0.10-0.71, p = 0.016). These data suggest that perioperative beta-blockers confer a benefit which is mostly limited to patients undergoing high-risk surgery.
Angeli
Fabio
F
Department of Cardiology, Hospital Santa Maria della Misericordia, Perugia, Italy. fangeli@cardionet.it
Verdecchia
Paolo
P
Karthikeyan
Ganesan
G
Mazzotta
Giovanni
G
Repaci
Salvatore
S
del Pinto
Maurizio
M
Gentile
Giorgio
G
Cavallini
Claudio
C
Reboldi
Gianpaolo
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D006801:Humans; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*
D000319:Adrenergic beta-Antagonists