Effect of beta-blockers on perioperative myocardial ischemia in patients undergoing noncardiac surgery

Myocardial ischemia remains a major cause of morbidity in patients undergoing noncardiac surgery. The purpose of the paper was to review the evidence of the use of perioperative beta-blockers for the reduction of myocardial ischemia in patients having noncardiac surgery.

Pubmed was searched for articles that included beta-blockers and perioperative myocardial ischemia. Randomized controlled trials that assessed the effect of beta-blockers on myocardial ischemia in patients undergoing noncardiac surgery were included in this review and a meta-analysis were performed.

Sixteen randomized controlled trials including 2230 patients were included. The study methodologies and results were summarized and meta-analysis performed. Ten trials used beta-blockers in the postoperative period; 954 patients received beta-blockers and 924 patients in the control group. Of the six trials that used beta-blocker for premedication, there were 207 patients in the beta- blocker and 145 patients in the control group. For the cohort when beta-blockers were used postoperatively, myocardial ischemia was reduced significantly with the use of beta-blockers (OR 0.42; 95% CI 0.27-0.65; P=0.0001; I(2)=0%). A similar beneficial effect was observed in trials that used beta- blocker for premedication (OR 0.16; 95% CI 0.07-0.35; P%lt;0.00001; I(2)=40%).

The meta-analysis shows that the use of beta-blockers, both as premedication and postoperatively, in noncardiac surgery is associated with a significant reduction in perioperative myocardial ischemia.