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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2009 Maggio;75(5):319-23
Influence of beta-blockers on the outcome of at risk patients
Joachim Priebe H.
Department of Anaesthesia, University Hospital Freiburg, Freiburg, Germany
Present recommendations for perioperative ß-blockade are solely based on the findings of two randomized controlled trials of inadequate methodology and data analysis in just a little over 300 patients performed in the late 1990s. The PeriOperative ISchemic Evaluation study is the first adequately powered controlled randomized trial on the efficacy and safety of perioperative ß-blocker therapy. During the first 30 postoperative days, the primary endpoint (combined cardiovascular death, non-fatal myocardial infarction and cardiac arrest) was significantly less in the ß-blocker compared to the placebo group, primarily due to a marked reduction in the incidence of non-fatal myocardial infarctions. However, in the ß-blocker group total mortality and the incidence of stroke were higher, negating the beneficial effect of perioperative ß-blocker therapy on the primary endpoint. A recently published meta-analysis confirmed in large parts these findings. Based on these publications, most of the present recommendations for perioperative ß-blocker therapy are no longer supported by evidence and respective revision is needed.