Postoperative Prophylactic Administration of β-Adrenergic Blockers in Patients at Risk for Myocardial Ischemia

Abstract

Prophylactic beta adrenergic blockade administered after elective total knee arthroplasty was associated with a reduced prevalence and duration of postoperative myocardial ischemia detected with Holter monitoring.

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis

“…High-bias risk trials POBBLE 3 Poldermans 32 Jakobsen 46 Jakobsen 34 Lai 35 Magnusson 37 Magnusson 50 Stone 38 Urban 39 Zaugg 3 Poldermans 32 Jakobsen 46 Lai 35 Magnusson 37 Magnusson 50 Miller 40 Stone 38 Urban 39 Zaugg High-bias risk trials Jakobsen 426 Lai 35 Liu 36 Magnusson 50 POBBLE 3 Poldermans 32 Urban 39 Zaugg 33 Jakobsen 46 Stone …”

“…High-bias risk trials Coleman 42 Lai 35 Liu 36 Magnusson 36 POBBLE 3 Poldermans 32 Stone 38 Urban 39 Zaugg 33 Liu 48 33 trials included 12 306 patients having non-cardiac surgery, 6311 (51%) patients randomly assigned to the β-blocker group, and 5995 (49%) to the control group. The β blocker used, dose given, timing of administration, and the duration of administration varied in the trials (table 1).…”

“…[3][4][5][6]22,24,28,[30][31][32][33][34][35][36][37][38][39] However, the test for interaction did not show a significant effect of age category on any of the efficacy outcomes.…”

“…Five trials enrolled high surgical-risk patients (emergency surgery, vascular surgery), 3,5,27,32,40 five enrolled intermediate-risk or high surgical-risk patients, 4,6,28,30,38 22 enrolled intermediate surgical-risk patients (intrathoracic, intraperitoneal, carotid endarterectomy, head and neck, orthopedic, or prostate surgery), [22][23][24][25][26]31,[33][34][35][36][37]39,[41][42][43][44][45][46][47][48][49][50] and one enrolled low surgical-risk patients. 29 A sensitivity analysis on the basis of surgical risk categories showed a 63% decreased risk of all-cause mortality and a 44% decreased risk of non-fatal myocardial infarction in trials with high surgical risk (tables 2 and 3); this finding was driven largely by the trial by Poldermans and colleagues.…”

“…32 However, in the intermediate-high surgical risk trials, there was a 30% reduction in the risk of non-fatal myocardial infarction, 66% reduction in the risk of myocardial ischaemia, at the expense of a 35% increased risk of all-cause mortality and a 113% increased risk of non-fatal stroke (tables 2 and 3), which was driven mainly by the POISE trial. 6 In 14 trials, the study drug was given for more than 1 day, [3][4][5][6]22,27,28,[30][31][32][33][34][35]39 whereas the rest of the trials used the study drugs for 1 day or less. A test for interaction suggested a role of duration of β blockade for the outcome of myocardial ischaemia such that patients who received β blockade for 1 day or less had a greater decrease in the risk of myocardial ischaemia than did those who received the treatment for longer (84% vs 55% decrease; tables 2 and 3).…”