Beta Blockade to Decrease Silent Myocardial Ischemia During Peripheral Vascular Surgery

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Only 3% of patients experienced an acute MI compared with 18% for matched control subjects. Pasternack et al (78) subsequently reported fewer episodes of intraoperative ischemia in patients treated with oral metoprolol before peripheral vascular surgery than in untreated patients. Yeager et al (375) reported a case-control analysis of their experience with perioperative MI during vascular surgery, comparing 53 index cases of perioperative MI with 106 matched control subjects.…”

“…In addition, several investigators have demonstrated exaggerated intraoperative blood pressure fluctuation with associated ECG evidence of myocardial ischemia in patients with preoperative blood pressure elevation (74 -77). This effect can be modified by treatment (75)(76)(77)(78)(79)(80). Because intraoperative ischemia correlates with postoperative cardiac morbidity (71,81), it follows that control of blood pressure preoperatively may help reduce the tendency to perioperative ischemia.…”

“…Alternatively, beta blockers appear to be particularly attractive agents for the treatment of preoperative high blood pressure. Several reports have shown that the introduction of preoperative beta-adrenergic blockers leads to effective modulation of severe blood pressure fluctuations and a reduction in the number and duration of perioperative coronary ischemic episodes (75)(76)(77)(78)(79)(80). The preoperative administration of betaadrenergic blocking drugs has been shown to decrease the incidence of postoperative atrial fibrillation (86), and in patients who have or are at risk for CAD who must undergo noncardiac surgery, treatment with beta blockers during hospitalization can reduce mortality and the incidence of cardiovascular complications (87,88).…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade

“…Only 3% of patients experienced an acute MI compared with 18% for matched control subjects. Pasternack et al (17) subsequently reported fewer episodes of intraoperative ischemia in patients treated with oral metoprolol before peripheral vascular surgery than in untreated patients. Yeager et al (18) reported a case-control analysis of their experience with perioperative MI during vascular surgery, comparing 53 index cases of perioperative MI with 106 matched control subjects.…”

ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy

“…Only 3% suffered an acute MI compared with 18% for matched controls. Pasternack et al (11) subsequently reported fewer episodes of intraoperative ischemia in patients treated with oral metoprolol before peripheral vascular surgery compared with untreated patients. Yeager et al (12) reported a case-control analysis of their experience with perioperative MI during vascular surgery, comparing 53 index cases of perioperative MI with 106 matched controls.…”