Abstract 1558: Role of Peri-Operative Beta-Blockers in Patients Undergoing Non-cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials
Background: ACC/AHA guidelines recommend peri-operative beta-blockers (BB) in patients undergoing non-cardiac surgery. However, since recent large trials showed no benefit, this recommendation has become controversial.
Methods: We performed a MEDLINE search of studies using the terms: perioperative, BB and surgery. The search was limited to randomized controlled trials in patients undergoing non-cardiac surgery. Peri-operative composite endpoint was defined as a composite of all-cause mortality, non-fatal myocardial infarction, myocardial ischemia, stroke and heart failure within 30-days of surgery.
Results: Only 31 studies, enrolling 2128 patients on BB and 1818 patients on placebo, fullfilled our inclusion criteria. Compared to placebo, peri-operative BB therapy resulted in a 44% decreased risk of composite endpoints (16.7% vs. 10.5%; P<0.0001), driven largely by a 52% decreased risk of myocardial ischemia. However, it was no more beneficial than placebo for the secondary outcomes of all-cause mortality, cardiovascular mortality, non-fatal MI, stroke or heart failure and was associated with a 129% and a 28% increased risk of peri-operative bradycardia and hypotension respectively (Figure⇓).
Conclusions: BB therapy is associated with a significant reduction in the risk of peri-operative composite endpoint driven largely by reduction in the soft endpoint of myocardial ischemia without effect on all-cause mortality, cardiovascular mortality, stroke or heart failure and is associated with increased risk of bradycardia and hypotension.