[Perioperative pharmacological myocardial protection. Systematic literature-based process optimization].

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Perioperative beta-blockade is recommended for patients with cardiac risk factors.
• Current recommendations are based on heterogeneous trial data with conflicting results.
• Evidence supports beta-blockers mainly for high-risk vascular surgery patients.

Purpose of the Study:

• To critically evaluate the evidence for perioperative beta-blockade.
• To propose an individualized risk-benefit analysis protocol for beta-blocker therapy.
• To offer a clinical concept for implementing perioperative beta-blockade.

Main Methods:

• Review and interpretation of scientific literature and randomized trials.
• Analysis of study results, including divergent findings and adverse effects.
• Development of a standardized protocol based on risk stratification (e.g., Revised Cardiac Risk Index).

Main Results:

• Beta-blocker benefits are limited to a specific subpopulation of high-risk patients undergoing vascular surgery.
• Treatment is not beneficial for intermediate-risk patients and potentially harmful for low-risk patients.
• High-dose metoprolol (POISE trial) reduced cardiovascular events but increased total mortality due to adverse effects.

Conclusions:

• Individualized risk-benefit assessment is essential for rational perioperative beta-blocker therapy.
• Standardized protocols incorporating risk indices are necessary.
• Careful dose adjustment, safety monitoring, and consideration of adverse effects like hypotension and bradycardia are mandatory.