title: Different β-blockers and initiation time in patients undergoing noncardiac surgery: a meta-analysis.
abstract: The effects of differences among β-blockers and initiation times in patients undergoing noncardiac surgery (NCS) remain unknown. On June 1, 2012, the authors searched PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to identify all trials of perioperative β-blockers in patients undergoing NCS published between January 1960 and June 2012. The authors included only randomized, double-blind and placebo-controlled trials of perioperatively administered β-blockers (ie, during the pre-, intra- and/or postoperative period) in patients with at least 1 risk factor for coronary artery disease undergoing NCS. The endpoints of these trials had to include all-cause mortality, myocardial infarction (MI) and/or stroke. The authors identified 8 English-language publications, involving 11,180 patients, which fulfilled our inclusion criteria. Perioperative β-blocker therapy was associated with a significant decrease in patient risk of developing MI (relative risk [RR] = 0.73; 95% confidence interval [CI], 0.61-0.86) but a significant increase in risk of developing stroke (RR = 2.17; 95% CI, 1.35-3.50) versus placebo, resulting in a nonsignificant decrease in overall mortality (RR = 0.91; 95% CI, 0.60-1.36). Indirect comparisons demonstrated that perioperative atenolol therapy was associated with lower mortality and incidence of MI. β-blocker therapy initiated >1 week before surgery was associated with improved postoperative mortality. Perioperative β-blocker treatment of patients undergoing NCS increases the incidence of stroke but decreases the incidence of MI, leading to a nonsignificant decrease in mortality. The authors also observed that atenolol treatment or β-blocker therapy initiated >1 week before NCS was associated with improved outcomes.
authors.affiliation: Cardiology Department (ND, DX, JZ, YW, WL, YX), Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; and Cardiology Department (BF), Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Neng
authors.initials: N
authors.lastname: Dai
authors.forename: DaChun
authors.initials: D
authors.lastname: Xu
authors.forename: Ji
authors.initials: J
authors.lastname: Zhang
authors.forename: Yidong
authors.initials: Y
authors.lastname: Wei
authors.forename: WeiMing
authors.initials: W
authors.lastname: Li
authors.forename: Bing
authors.initials: B
authors.lastname: Fan
authors.forename: YaWei
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D001919:Bradycardia / Q000139:chemically induced; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D013514:Surgical Procedures, Operative
chemical_list: D000319:Adrenergic beta-Antagonists