Abstract
Purpose
Our aim was to analyze the current scientific literature relevant to the use of β-adrenergic
receptor antagonists for the prevention of cardiovascular morbidity and mortality
in patients undergoing noncardiac surgery.
Methods
A PubMed search was conducted for the following concepts: pre- or perioperative, β-adrenergic
receptor antagonist, treatment outcome, and cardiovascular complication. Randomized
clinical trials measuring the effect of β-adrenergic blocking agents against that
of placebo on cardiovascular outcomes after noncardiac surgery were included in the
review.
Findings
Two small randomized controlled trials published in 1996 and 1999 reported associations
between perioperative β-blockade and significant reductions in long-term and 30-day
cardiac mortality, respectively. These 2 studies prompted guideline changes in 2002
encouraging perioperative β-blockade in subsets of noncardiac surgery patients. However,
subsequent trials failed to validate these results. In 2008, the first large randomized
controlled trial on the topic was published and found an association between perioperative
β-blockade and an increase in perioperative mortality. Furthermore, in 2011, the lead
author of the 1999 study was dismissed from his academic position for scientific misconduct,
casting doubt on the validity of guidelines based on his work. Existing studies are
highly heterogeneous, making comparisons difficult. Current literature does not support
initiating perioperative β-blockade in noncardiac surgery patients not already receiving
these medications.
Implications
Future research on the topic should account for the influence individual genetic variation
can have on outcomes and β-blocker metabolism. Additionally, the relationship between
outcomes and the β-1 selectivity of different β-blockers should be explored.
Key words
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Article info
Publication history
Published online: September 22, 2016
Accepted:
August 25,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
