Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2010 Oct;53(5):342-4.

CAGS and ACS Evidence Based Reviews in Surgery. 34: effects of ß-blockers in patients undergoing noncardiac surgery

Tara M Mastracci, Mary-Anne Aarts, Stephen D Cassivi, Santiago A Garcia, Richard F McLean, Edward O McFalls; Members of the Evidence Based Reviews in Surgery Group
Collaborators
Comment

CAGS and ACS Evidence Based Reviews in Surgery. 34: effects of ß-blockers in patients undergoing noncardiac surgery

Tara M Mastracci et al. Can J Surg. 2010 Oct.

Abstract

Question: Do ß-blockers have an effect on the 30-day risk of major cardiovascular events in patients with or at risk of atherosclerotic disease undergoing noncardiac surgery?

Design: Randomized controlled trial.

Setting: Multicentre trial in 190 hospitals in 23 countries.

Patients: In total, 8351 patients with or at risk of atherosclerotic disease undergoing noncardiac surgery.

Intervention: Patients were randomly assigned by a computerized 24-hour phone service to receive extended-release metoprolol succinate 200 mg (n = 4174) or placebo (n = 4177). Treatment was started 2-4 hours before surgery and continued for 30 days.

Main outcome: Cardiovascular death, nonfatal myocardial infarction (MI) and nonfatal cardiac arrest.

Results: Of those randomized, 8331 (99.8%) patients completed the 30-day follow-up. Fewer patients in the metoprolol group than in the placebo group had an MI (176 [4.2%] v. 239 [5.7%] patients; hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.60-0.089, p = 0.0017). However, there were more deaths in the metoprolol group than in the placebo group (129 [3.1%] v. 97 [2.3%] patients; HR 1.33, 95% CI 1.03-1.74, p = 0.0317). More patients in the metoprolol group than in the placebo group had a stroke (41 [1.0%] v. 19 [0.5%] patients; HR 2.17, 95% CI 1.26-3.74, p = 0.0053).

Conclusion: A perioperative ß-blocker regimen results in fewer MIs but is associated with an increased risk of stroke and perioperative death in patients with or at risk for atherosclerotic disease undergoing noncardiac surgery. Patients are unlikely to accept the risks associated with perioperative extended-release metoprolol use.

PubMed Disclaimer

Comment on

References

    1. Evidence-Based Medicine Working Group. Evidence-based medicine. JAMA. 1992;268:2420–5. - PubMed
    1. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery a modeling strategy bases on available data. Lancet. 2008;372:139–44. - PubMed
    1. Deveraux PJ, Goldman L, Cook DJ, et al. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 2005;173:627–34. - PMC - PubMed
    1. POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839–47. - PubMed
    1. Auerbach AD. Changing the practice of perioperative cardioprotection: perioperative beta-blockers after POISE (PeriOperative ISchemic Evaluation) Circ Cardiovasc Qual Outcomes. 2008;1:58–61. - PubMed