Perioperative Beta-Blockers in the Prevention of Perioperative Myocardial Infarction in non-Cardiac Surgery

Abstract

erformed annually worldwide, and this number grows continuously. The 30-day mortality associated with moderate- to high-risk noncardiac surgery in recent large cohorts and population-based studies exceeds 2% and surpasses 5% in patients at high cardiac risk. Cardiac complications constitute the most common cause of postoperative morbidity and mortality, having considerable impact on the length and cost of hospitalization. As our population ages, more high-risk cardiac patients will undergo surgery, and perioperative myocardial infarction (PMI) can be an increasing problem. We searched Pubmed and Embase for randomised controlled trials investigating the use of β blockers in non-cardiac surgery. We extracted data for 30-day all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, heart failure, and myocardial ischaemia, safety outcomes of perioperative bradycardia, hypotension, and bronchospasm 33 trials included 12 306 patients. β blockers were not associated with any significant reduction in the risk of all-cause mortality, cardiovascular mortality, or heart failure, but were associated with a decrease (odds ratio [OR] 0•65, 95% CI 0•54–0•79) in non-fatal myocardial infarction (number needed to treat [NNT] 63) and decrease (OR 0•36, 0•26–0•50) in myocardial ischaemia (NNT 16) at the expense of an increase (OR 2•01, 1•27–3•68) in n